title: Doctors' and nurses' views and experience of transferring patients from critical care home to die: a qualitative exploratory study.
abstract: BACKGROUND
  Dying patients would prefer to die at home, and therefore a goal of end-of-life care is to offer choice regarding where patients die. However, whether it is feasible to offer this option to patients within critical care units and whether teams are willing to consider this option has gained limited exploration internationally.
  
  
  OBJECTIVE
  To examine current experiences of, practices in and views towards transferring patients in critical care settings home to die.
  
  
  METHODS
  Exploratory two-stage qualitative study
  
  
  METHODS
  Six focus groups were held with doctors and nurses from four intensive care units across two large hospital sites in England, general practitioners and community nurses from one community service in the south of England and members of a Patient and Public Forum. A further 15 nurses and 6 consultants from critical care units across the United Kingdom participated in follow-on telephone interviews.
  
  
  RESULTS
  The practice of transferring critically ill patients home to die is a rare event in the United Kingdom, despite the positive view of health care professionals. Challenges to service provision include patient care needs, uncertain time to death and the view that transfer to community services is a complex, highly time-dependent undertaking.
  
  
  CONCLUSIONS
  There are evidenced individual and policy drivers promoting high-quality care for all adults approaching the end of life encompassing preferred place of death. While there is evidence of this choice being honoured and delivered for some of the critical care population, it remains debatable whether this will become a conventional practice in end of life in this setting.
authors.affiliation: Graduate School of Nursing, Midwifery and Health, Victoria University of Wellington, Wellington, New Zealand Faculty of Health Sciences, University of Southampton, Southampton, UK.
authors.forename: Maureen
authors.initials: M
authors.lastname: Coombs
authors.affiliation: Faculty of Health Sciences, University of Southampton, Southampton, UK T.Long@soton.ac.uk.
authors.forename: Tracy
authors.initials: T
authors.lastname: Long-Sutehall
authors.affiliation: Faculty of Health Sciences, University of Southampton, Southampton, UK.
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Darlington
authors.affiliation: Faculty of Health Sciences, University of Southampton, Southampton, UK.
authors.forename: Alison
authors.initials: A
authors.lastname: Richardson
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003422:Critical Care / Q000458:organization & administration*; D005260:Female; D017144:Focus Groups; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer; D036301:Qualitative Research; D013727:Terminal Care / Q000458:organization & administration*; D006113:United Kingdom
keywords: Critical care; doctors and nurses; end-of-life care; transfer home