Clinical Review

Care of the dying patient in the community

BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f4085 (Published 03 July 2013) Cite this as: BMJ 2013;347:f4085
  1. Emily Collis, consultant in palliative medicine 1,
  2. R Al-Qurainy, community consultant in palliative medicine1
  1. 1Pembridge Palliative Care Centre, Central London Community Healthcare Trust, St Charles Centre for Health and Wellbeing, London W10 6DZ, UK
  1. Correspondence to: E Collis emily.collis{at}clch.nhs.uk

Summary points

  • Most people report a preference to die at home

  • To support this preference, doctors in all settings need to identify relevant patients early

  • Anticipatory care planning should include discussion and documentation of patient preferences, anticipatory prescribing, and completion of a do not attempt cardiopulmonary resuscitation order

  • General practitioners have a key role, in both homes and care homes, before and after death

  • Good communication and effective coordination of care 24 hours a day are essential to prevent unwanted and unnecessary hospital admissions towards the end of life

The consensus from international studies of patient preferences is that, given adequate support, most people would prefer to die at home.1 2 3 However, more than half of all deaths in the United Kingdom occur in hospital, with only 18% of people dying in their own home.4 Suggested reasons for this include a lack of anticipatory care planning, poor coordination between healthcare agencies, and insufficient community resources. National and local policies now focus on facilitating home deaths, and recently there has been a small increase in the proportion and absolute number of people dying at home.5

The demographics of deaths across Europe are changing with the ageing population, with deaths from dementia, cancer, and chronic diseases becoming more common.6 7 Caring for such patients in hospital will probably become unsustainable in terms of capacity, cost, and patient satisfaction. The focus of end of life care is therefore shifting to the community—to homes and care homes—where the role of the general practitioner, with support from the community palliative care team, is key. The onus is on all health and social care professionals to work collaboratively across settings to enable patients to receive high quality end of life care in the place of their choice.

Sources and selection criteria

We searched the Cochrane Database of …

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