title: Exploring preferences for place of death with terminally ill patients: qualitative study of experiences of general practitioners and community nurses in England.
abstract: OBJECTIVE
  To explore the experiences and perceptions of general practitioners and community nurses in discussing preferences for place of death with terminally ill patients.
  
  
  METHODS
  Qualitative study using semistructured interviews and thematic analysis.
  
  
  METHODS
  17 general practitioners and 19 nurses (16 district nurses, three clinical nurse specialists).
  
  
  METHODS
  15 general practices participating in the Gold Standards Framework for palliative care from three areas in central England with differing socio-geography. Practices were selected on the basis of size and level of adoption of the standards framework.
  
  
  RESULTS
  All interviewees bar one had experience of discussing preferred place of death with terminally ill patients. They reported that preferences for place of death frequently changed over time and were often ill defined or poorly formed in patients' minds. Preferences were often described as being co-created in discussion with the patient or, conversely, inferred by the health professional without direct questioning or receiving a definitive answer from the patient. This inherent uncertainty challenged the practicability, usefulness, and value of recording a definitive preference. The extent to which the assessment of enabling such preferences can be used as a proxy for the effectiveness of palliative care delivery is also limited by this uncertainty. Generally, interviewees did not find discussing preferred place of death an easy area of practice, unless the patient broached the subject or led the discussions.
  
  
  CONCLUSIONS
  Further research is needed to enable development of appropriate training and support for primary care professionals. Better understanding of the importance of place of death to patients and their carers is also needed.
authors: Health Sciences Research Institute, Warwick Medical School, University of Warwick, Coventry CV4 7AL. d.munday@warwick.ac.uk
authors: Daniel
authors: D
authors: Munday
authors: Mila
authors: M
authors: Petrova
authors: Jeremy
authors: J
authors: Dale
mesh_terms: D001291:Attitude of Health Personnel; D001293:Attitude to Death; D003142:Communication; D003152:Community Health Nursing; D004739:England; D005194:Family Practice; D006801:Humans; D017060:Patient Satisfaction; D010465:Perception; D011369:Professional-Patient Relations; D012111:Residence Characteristics; D013727:Terminal Care; D019452:Terminally Ill / Q000523:psychology*