New research highlights how hospitals can help critically ill people go home to die

by Professor Alison Richardson Clinical Professor in Cancer Nursing and End of Life Care, University of Southampton Professor Alison Richardson, University of Southampton

Most people would prefer to die peacefully at home rather than in hospital, a choice Marie Curie is committed to making possible.
While many healthcare professionals share this commitment, it is not always straightforward to arrange for people who are in critical care in hospital to go home to die – even when they and their family express this wish. At the moment, the transfer from critical care to home happens relatively infrequently. The Faculty of Health Sciences at the University of Southampton has undertaken a research project, funded by Marie Curie, to address this issue. Building on the results, the researchers have developed guidance to help clinical teams explore how someone who is critically ill can be taken home to die.

Knowledge gap

Not much is known about what happens at the very end of a critically ill person’s life and how health professionals take patients’ wishes into account. There are only a few published accounts about how doctors and nurses in critical care support patients and families to honour a wish of death at home. None of these relate to the situation in the UK. The researchers carried out a national survey of critical care staff to investigate their experiences and attitudes towards transferring patients in critical care home to die. Of those surveyed 36% had some experience of transfer and the majority agreed it was a good idea in principle. Researchers also held a series of discussion groups and interviews with nurses and doctors in four intensive care units. While health professionals were again very positive about enabling patients to go home, they also highlighted several barriers.

Logistical challenges

These include a lack of a working relationship between critical care teams in hospitals and healthcare professionals in the community as well as difficulties mobilising a team to accompany the patient during the transfer. Health professionals also said they were anxious about how relatives would cope once the patient has been transferred home. Once treatment is withdrawn, it can be anything from a few minutes to a few days until the person dies – and this uncertainty creates further challenges. It can be difficult to organise everything that is needed in a short period of time, including the ambulance transport and equipment the person needs to be comfortable at home. The hospital must work very quickly with the patient’s GP and community nursing team to put all the arrangements in place. Encouragingly, researchers found that doctors and nurses are committed to helping people in critical care die at home, if this is their place of choice. We hope the research and new guidelines will make it easier for teams to make decisions about options for end of life care and put the arrangements in place for those whose last wish is to die at home.