Aims The Department of Health proposes “to offer all adult patients, regardless of their diagnosis … access to high quality palliative care so that they can choose … to die at home.” We, therefore, studied those with lung cancer patients who died in our institution during 2010.
Results 41 patients (33% of our annual notifications) died in hospital; 26 case records were retrieved complete (all had previously been diagnosed with lung cancer); mean age 70.6 years (53–85). 25 lived in their own dwelling (5 alone; 2 of these with only social care support) and 1 in a nursing home. 5 had been in receipt of radical treatments; 21 were in receipt of palliative interventions and the nursing home resident had no active treatment. Mean time from diagnosis to final admission was 296 (188 for those without radical treatments) days. 13 patients admitted via GP; six through A&E seven from Oncology or Palliative Care outpatients. 12 had acute medical problems (eg, pneumonia, CCF); one had intestinal obstruction; 11 had progressive disease-related symptoms (eg, progressive brain metastases); two had social issues precipitating admission. No clear documentation of preferred place of death was identified at admission; during this final admission 14 indicated their preferred place of death—10 for home; four were too unwell for discharge; one had unaddressed social issues; three families couldn't cope and two were re-admitted by their GP within 24 h of discharge. All patients were in receipt of specialist palliative care during the admission and 15 died on the Liverpool Care Pathway.
Conclusion 50% of these lung cancer patients (representing 16% of our annual cases) were admitted with acute medical problems. Those identified as wishing to die at home were unable to be discharged. To prevent the remaining 50% of this population being admitted to hospital will require a significant change in practice by both primary and secondary care teams and an investment in community palliative care services. In-hospital palliative care is of a very high standard.
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