A study looking at factors affecting where people with blood cancers are cared for at the end of life

The study team found that the idea of preferred place to die was complex with many related factors.

The team interviewed 56 people:

• 23 doctors
• 23 nurses
• 10 relatives of people who died from a blood cancer

The researchers also looked at the medical records of 886 people who had died from a blood cancer. 

The team found that there were differences in how people viewed a hospital death, and that some people wanted to die in hospital. 

There were also differences between what doctors thought about place of death. Some doctors questioned the idea that ‘the only good death is a home death’. While others believed that dying at home was preferable. 

Blood cancers can be unpredictable and patients can become ill very quickly. The treatments for blood cancers are often very long with many serious side effects. 

Reasons why people with blood cancers went into hospital and died there were:

• a sudden worsening of their condition
• distressing symptoms
• unrealistic expectation of home death and what support was available

Everyone also recognised that people’s preferences do change.  

The researchers collected information about any talks that had taken place about dying and particularly: 

• where patients wanted to die  
• who was involved in the talks
• how the decision was made about where they wanted to die

They found evidence that 52 out of every 100 people (52%) had talked about where they preferred to die. For most of these people this subject had been talked about many times, although not all had come to a final decision. 

The team found that the preferred place of death changed as the cancer got worse. The first time it was discussed the number of people who preferred to die:

• in hospital was 11 out of every 100 people (11.1%)
• at home was 51 out of every 100 people (51.4%)
• in a care home was 10 out of every 100 people (10.9%)
• in a hospice was 12 out of every 100 people (12.4%)
• were undecided was 14 out of every 100 people (14.2%)

As the disease became worse preferred placed of death changed and the number of people who wanted to die in hospital increased. The final time it was discussed the number of people who preferred to die:

• in hospital was 19 out of every 100 people (19.3%)
• at home was 42 out of every 100 people (42.3%)
• in a care home was 13 out of every 100 people (13.9%)
• in a hospice was 15 out of every 100 people (15.6%)
• were undecided was 8 out of every 100 people (8.9%)

The team found that number of people who actually died:

• in hospital was 57 out of every 100 people (57.7%) 
• at home was 20 out of every 100 people (20.1%)
• in a care home was 12 out of every 100 people (12.1%)
• in a hospice was 10 out of every 100 people (10.1%)

The team found there were many factors involved in deciding on the preferred place to die. These included:

• when the talk about preferred place to die took place
• who was asked (the patients or their relatives)

Hospital was preferred more often when the talk was closest to death and when it only involved relatives and not the dying person. 

As a person’s preferred place can change over time, this should be discussed and reassessed regularly. 

For people to make meaningful choices there needs to be enough nurses to provide adequate care for those whose desire is to die at home. There also needs to be enough beds at short notice for those wanting to die in a hospice.

Many doctors said that if people nearing the end of their life are to remain at home, GPs and nurses need to know about this as soon as possible, as a lot of help may be needed and this can take time to set up. 

We have based this summary on information from the research team. The information they sent us has been reviewed by independent specialists (peer reviewed ) but may not have been published in a medical journal.  The figures we quote above were provided by the research team. We have not analysed the data ourselves.