title: Place of care: from referral to specialist palliative care until death.
abstract: BACKGROUND
  While there are many poorly standardised studies focusing on place of death, there are limited data on place(s) of care during the final stages of disease.
  
  
  OBJECTIVE
  This study aims to identify where patients are cared for in the interval from referral to specialist palliative care until death.
  
  
  METHODS
  All patients who died while under the care of a specialist palliative care service over a 6-month period were considered.
  
  
  RESULTS
  Of the 507 patients included, 255 (50.3%) were men and 428 (84.4%) had a malignant diagnosis. The mean referral-to-death interval was 70 days (SD 113, Range 1-838). The majority (n=281, 55.4%) received care in a single care setting-hospital (28.4%), home (21.5%), nursing home/community hospital (4.1%), hospice (1.4%)-and had a shorter mean referral-to-death interval. Most patients with more than one care setting spent three-quarters of their time in their normal place of residence. A total of 199 (39.3%) died in hospital, 131 (25.8%) in hospice, 131 (25.8%) at home (25.8%) and 46 (9.1%) in a nursing home/community hospital. Patients referred by a general practitioner (n=80 patients, 15.8%) were more likely to be cared for at home (p<0.001), and die at home (p<0.001).
  
  
  CONCLUSIONS
  A significant number of patients received specialist palliative care across multiple care settings. Late referral is associated with a single domain of care. General practitioner involvement supports patient care and death at home. Place of care and ease of transfer between care settings may be better indicators of the quality of care we provide.
authors.affiliation: Palliative Medicine, Marymount University Hospital and Hospice, Cork, Ireland.|Hospice Palliative & End of Life Care, Fraser Health Authority, British Columbia, Canada.
authors.forename: Mary Jane
authors.initials: MJ
authors.lastname: O'Leary
authors.affiliation: Department of Epidemiology and Public Health, University College Cork, Cork, Ireland.
authors.forename: Alison C
authors.initials: AC
authors.lastname: O'Brien
authors.affiliation: Palliative Medicine, Marymount University Hospital and Hospice, Cork, Ireland.|Palliative Medicine, Mercy University Hospital, Cork, Ireland.
authors.forename: Marie
authors.initials: M
authors.lastname: Murphy
authors.affiliation: Palliative Medicine, Bon Secours Hospital, Cork, Ireland.
authors.forename: Claire M
authors.initials: CM
authors.lastname: Crowley
authors.affiliation: Palliative Medicine, South Infirmary-Victoria University Hospital, Cork, Ireland.
authors.forename: Helen M
authors.initials: HM
authors.lastname: Leahy
authors.affiliation: Palliative Medicine, South Infirmary-Victoria University Hospital, Cork, Ireland.
authors.forename: Jill M
authors.initials: JM
authors.lastname: McCarthy
authors.affiliation: Palliative Medicine, Cork University Hospital, Cork, Ireland.
authors.forename: Joan C
authors.initials: JC
authors.lastname: Collins
authors.affiliation: Palliative Medicine, Marymount University Hospital and Hospice, Cork, Ireland.|Palliative Medicine, Cork University Hospital, Cork, Ireland.
authors.forename: Tony
authors.initials: T
authors.lastname: O'Brien
mesh_terms: D000368:Aged; D003643:Death; D005260:Female; D006268:Health Facilities / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D010166:Palliative Care / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D013727:Terminal Care / Q000706:statistics & numerical data*; D013997:Time Factors
keywords: Communication; Home care; Hospice care; Hospital care; Nursing Home care