title: Do place-of-death preferences for patients receiving specialist palliative care change over time?
abstract: BACKGROUND
  Discussing preferred place of death (PPD) with patients approaching end of life is an important part of anticipatory care planning. Preferences at a specific point in time have been described; however the extent to which preferences may change is unclear. This study examines changes in PPD.
  
  
  METHODS
  A retrospective case note review of all patients who died under the care of a specialist palliative care service during a 6-month period in 2012 was undertaken. Notes relating to 299 patients were examined by a member of the clinical team.
  
  
  RESULTS
  Of the 204 patients who had more than one PPD assessment, 57% showed a change in preference status between the first and last assessment. The majority changed from an unclarified preference to identifying a preferred place. Only 15% of patients with two or more assessments switched from one location to another.
  
  
  CONCLUSIONS
  Most patients under the care of a specialist palliative care service identify a preference for place of death as end of life approaches. Only a minority change their preference once a preferred place has been elicited. We recommend that patients are supported to explore their preferences for PPD as part of specialist palliative care, and that preferences are reviewed as end of life approaches.
authors.affiliation: Core Medical Trainee, South East Scotland Deanery, 102 Westport, Edinburgh, UK.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Evans
authors.forename: Anne
authors.initials: A
authors.lastname: Finucane
authors.forename: Lynsey
authors.initials: L
authors.lastname: Vanhegan
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Arnold
authors.forename: David
authors.initials: D
authors.lastname: Oxenham
mesh_terms: D003643:Death; D006801:Humans; D010166:Palliative Care; D057240:Patient Preference; D006113:United Kingdom
keywords: Advance care planning; Change in preference; End of life; Home care; Hospice care; Preferred place of death