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Best care for the dying patient

BMJ 2013; 347 doi: (Published 12 July 2013) Cite this as: BMJ 2013;347:f4428
  1. John E Ellershaw, professor of palliative medicine1,
  2. Mayur Lakhani, chairman 2
  1. 1Marie Curie Palliative Care Institute Liverpool (MCPCIL), Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Cancer Research Centre, Liverpool L3 9TA, UK
  2. 2National Council for Palliative Care, London N7 9AS, UK
  1. johne61{at}

Why do so many people die badly when we know how to care for them well?

What we want for the people we love and for ourselves is to die in the place of our choice and to experience a “good death”—dignified, free from pain, and supported by those we love. Ascertaining and documenting a patient’s preferred place of death is regarded as an important marker of the quality of care.

Around 500 000 people die in England every year—53% die in hospital, whereas 63% indicate a preference to die at home1; 92 000 have an unmet need for palliative care.2 Health inequalities, based on postcode and diagnosis, are common in end of life care. The case for improving end of life care is therefore compelling.3

Death at home is the “mantra,” but are we right about this? A recent systematic review of international evidence provided important insights about preferred place of care for dying patients.4 It found that most people express a preference to die at home, including those with advanced disease. However, the review recognised that preferences can depend on the quality of care that patients and carers have experienced.

For patients with …

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