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GPs and nurses need more training to help terminally-ill patients choose where to die

More training is needed to help GPs and nurses raise the difficult question of where a terminally-ill patient wishes to die.

Researchers at the University of Warwick interviewed general practitioners, district and clinical specialist nurses in the UK to explore their experiences of discussing preferences for place of death with patients.

The recent publication of the Department of Health’s End of Life Care Strategy for England has highlighted the importance of enabling patients to express preferences regarding end of life care and for recording these wishes in an advance care plan.

The study has been published in the latest issue of the British Medical Journal (25 July). Lead author of the study, Associate Clinical Professor in Palliative Medicine Dr Dan Munday, said more appropriate training and support was needed to help primary care professionals discuss preferred place of death with terminally-ill patients.

Dr Munday said: “Most interviewees reported that they did not find it easy to discuss preferred place of death with patients. General practitioners and community nurses described how they balanced the imperative given in guidelines to elicit preferred place of death with an assessment of the appropriateness of discussing the issue with patients.”

The research team, which also included Mila Petrova and Professor Jeremy Dale from the University of Warwick, interviewed 17 GPs and 19 nurses from 15 general practices participating in the Gold Standards Framework for palliative care in the UK.

Dr Munday added: “Preferences for place of death frequently change over time and are often ill-defined in the patient’s mind. We need more research to develop appropriate training and we need to better understand the importance of place of death to patients and their carers.”

Moreover, the authors also suggested that the inherent uncertainty surrounding preferences for place of deathchallenged 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.”

Notes to editors:
This study, Exploring preferences for place of death with terminally ill patients: qualitative study of experiences of general practitioners and community nurses in England was published in the British Medical Journal, BMJ  2009;339:b2391. It was funded by

Macmillan Cancer Support.

For more details or to arrange an interview with Dr Munday, please contact Kelly Parkes-Harrison, Communications Officer, University of Warwick,, 02476 574255, 07824 540863.