Over the last 10 years, one of the key themes of public policy in palliative care has been achievement of choice in place of @entity204 . In Marie Curie Hospice Edinburgh a baseline audit conducted in 2006 showed that only a small proportion (18%) of @entity1 referred to hospice services died at home. The audit also revealed that only 31% of those who expressed a preference to die at home were able to do so, whereas 91% of those who chose a setting other than home achieved their preference. Overall achievement of preferred place of @entity204 was 56%. However a significant number of @entity1 (29%) did not have a recorded preference. A programme of quality improvement has continued over the last 7 years to improve identification, communication and achievement of preferred place of @entity204 for all @entity1 . The mechanisms to change practice have been: changes to documentation; changes to clinical systems to support use of documentation; support for clinical staff to recognise the value of discussing preferences; and support for clinical staff to develop new skills. In addition the programme has been incorporated into local clinical strategy and this has enabled gaps in service to be addressed with a new service to support early discharge of those @entity1 who wish to die at home. A recent audit showed that all @entity1 had a recorded preference or a documented reason why their preference was unclarified. One third of @entity1 died at home - nearly double the proportion that died at home in the baseline audit. Seventy one per cent of @entity1 who wished to die at home actually died at home - a substantial increase from 31% at baseline. Achievement of preferred place of @entity204 for @entity1 wishing to die in the hospice remained high at 88%. The focus on assessment of preference for place of @entity204 has led to substantial improvements in the identification and achievement of preference for @entity1 dying under the care of the hospice. Furthermore, it has been associated with an increase in the overall proportion of @entity1 who die at home.

Delivering preference for place of XXXX in a specialist palliative care setting.

@entity1 :: ('9606', 'Species') :: ['patients'] @entity204 :: ('MESH:D003643', 'Disease') :: ['death']
@entity204 :: (MESH:D003643,Disease) :: ['death']
