title: Palliative care in people with idiopathic Parkinson's disease who die in hospital.
abstract: BACKGROUND
  The UK National Institute for Health and Clinical Excellence guidelines state that palliative care options for people with Parkinson's disease (PD) should be discussed.
  
  
  OBJECTIVE
  To investigate whether palliative care guidelines are adhered to for people with PD who die in hospital.
  
  
  METHODS
  The medical notes of all people with a diagnosis of idiopathic PD who were living in two adjacent areas of northeast England and who died over a 3-year period were examined. Demographic data and specific information regarding events around the time of death were recorded.
  
  
  RESULTS
  For the 236 patients identified, the average age at death was 82.8 years. Of these patients, 110 (46.6%) died in hospital, 56 (23.7%) at home, 59 (25.0%) in a care home and for 11 patients (4.7%) the place of death was not recorded. For those who died in hospital, only three patients, and seven relatives of patients, had had a recorded discussion with a clinician regarding their preferred place of death and only 15 (13.6%) were referred to a specialist palliative care team. Forty-six patients (41.8%) were placed on the Liverpool Care Pathway.
  
  
  CONCLUSIONS
  For those dying in hospital, there are few previously documented end-of-life care discussions with patients or their relatives. The use of end-of-life pathways and access to specialist palliative care is variable. Following the Neuberger report, the Liverpool Care Pathway is to be replaced with individual end-of-life care plans. It is important to engage patients, and their relatives, in decision making regarding preferences at the end of life.
authors.affiliation: Department of Medicine, North Tyneside General Hospital, North Shields, UK.
authors.forename: Richard W
authors.initials: RW
authors.lastname: Walker
authors.forename: Deepta
authors.initials: D
authors.lastname: Churm
authors.forename: Felicity
authors.initials: F
authors.lastname: Dewhurst
authors.forename: Maria
authors.initials: M
authors.lastname: Samuel
authors.forename: Amy
authors.initials: A
authors.lastname: Ramsell
authors.forename: Claire
authors.initials: C
authors.lastname: Lawrie
authors.forename: Jessica
authors.initials: J
authors.lastname: Hill
authors.forename: Christopher J D
authors.initials: CJ
authors.lastname: Threapleton
authors.forename: Brian
authors.initials: B
authors.lastname: Wood
authors.forename: William K
authors.initials: WK
authors.lastname: Gray
mesh_terms: D000369:Aged, 80 and over; D004739:England; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D010166:Palliative Care / Q000379:methods* / Q000706:statistics & numerical data*; D010300:Parkinson Disease / Q000628:therapy*; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000379:methods* / Q000706:statistics & numerical data*
keywords: Chronic conditions; Clinical decisions; Communication; Neurological conditions