Where Do Our Palliative Care Patients Die?

Introduction Palliative care essentially centralises in allowing a “good death” which revolves around having a patient-focused preference in the dying process. Home and hospice were the topmost on patients’ preference for place of death. Literature showed 10-70% of patients were unable to die in their preferred place of death. However, this statistic remains unknown in Malaysia. It is crucial to understand patients’ preferences for place of death and support them accordingly. This study aim to understand and compare the preferred and actual place of death (POD) of palliative care patients.

Methodology This is a cross-sectional study of patients admitted to Palliative Care Unit, Hospital Selayang between 01/01/2015 and 31/12/2017. Socio-demographic, clinical characteristics and information of preferred place of death were extracted from hospital medical records. The list of patients was matched with death registry to obtain the information on actual place of death.

Results A total of 1115 patients were identified, with 1073 (96.2%) successfully matched with death registry and included for further analysis. Mean age was 62.8 ±13.7 years old.

Discussion / Conclusion Malaysians had a lower preference towards non-hospital deaths compared to other countries. This can be due to many factors, including availability of hospice care, environmental, culture, psychosocial and many more. Further studies are needed to elucidate the reasons for the low preference among end-of-life care patients to die at non-hospital setting. In our study, the rate of mismatched place of death is low. However, this can be further improved by understanding patient’s preference for the place of death. In many countries, enquiry into patients’ preferences for the place of death is included into health guidelines and policy of many countries. 5,6 This is because it is found to be an objective, measurable and patient-centered outcome indicator. We hope that the study results can support the palliative care team in their strategic planning to improve palliative care service in our country.