Empowering Patients – Place Of Care (EPPOC)
In the UK around 600,000 people die from natural causes each year. The majority of these people would prefer to die at home, but less than 20% actually do so. EPPOC is a long-term project that aims to explore reasons for variations in place of care and death, differences between patient, professional and carer perspectives and the relationship between preferred place of care and place of death.
A systematic review analysed a large number of studies from many countries and reported strong evidence on the influence of several factors on the place where cancer patients die. These include the availability of home care and extended family support, and the preferences of patients and their families. The findings will have important implications for policies aiming to enable more people to die in the place of their choice. Indeed, an early outcome from the project is referred to in the 2006 White Paper on Health.
“The place where he died was old and bare. The paintwork was poor and there were no pictures. I would have had him home if I'd known about the care he could have had. I thought it was only available privately. Why don't they tell you you can take them home?”
Barbara Gomes, Cicely Saunders PhD fellow, is investigating ways of improving the quality and the cost-effectiveness of end of life care at home, in respect of people’s preferences for dying at home. She is now reviewing the literature on people’s preferences for place of care and death in terminal illness and economic evaluations of home palliative care.
The work and findings of this project were presented by Barbara Gomes at the NCRI Cancer Conference which took place in October 2007 in Birmingham. Participants at what is regarded as the UK‘s largest cancer conference and best showcase of British and international cancer research listened with great interest to the results of meta-analysis on what factors are associated with death at home. Some of the findings from EPPOC’s most recent work on projections for place of death in the UK (for publication shortly in Palliative Medicine) provoked a very important discussion amongst participants on future needs and plans for palliative care.
For more information, contact:
barbara.gomes@kcl.ac.uk