What influences decisions around the place of care for terminally ill cancer patients?

Abstract

Aim: To explore what factors influence decisions around the place of care for terminally ill cancer patients in a rural area in West Highland, Scotland.

Design: This was a descriptive, explorative, qualitative study using taped semistructured interviews.

Sample: A purposive sample of eight terminally ill cancer patients.

Results: The determinants for the desired place of care were organized into three main themes: carer resource and support; past experiences with death; and communication of wishes. The study evidenced that individuals often changed their preferred place of care at the end of life as the need for care increased. Those involved in the study found a therapeutic and emotional benefit by being able to discuss end-of-life care in a safe and secure environment.

Conclusion: For many, the preference for place of care at the end of life was conditional on how the process of their disease advanced. It was not a clear and positive choice, but it did include the desire to be cared for in a place other than home. Carer availability and ability were influencing factors; however, decisions reflected the patient's perceptions of resources rather than those of the carer, even when the carer was available and able. The challenge to those who work with the terminally ill is to develop effective interventions to facilitate discourses around end-of-life care, and thereafter, where possible, to facilitate those preferences.