• Alison Chapple, Julie Evans, Ann McPherson, and Sheila Payne.
• Department of Primary Health Care, University of Oxford, Oxford, UK.
• BMJ Support Palliat Care. 2011 Dec 1; 1 (3): 291-5.

ObjectiveTo explore reasons why people with pancreatic cancer, who are reaching the end of their lives, say they wish to die at home or elsewhere, and why preferences may change.DesignQualitative study using semistructured interviews followed by thematic analysis.SettingRespondents recruited from different parts of the UK during 2009/2010.Participants16 people with experience of pancreatic cancer (8 patients and 8 bereaved relatives) who discussed place of death in detail during an in-depth interview (from a total sample of 32 people with pancreatic cancer and eight relatives of others who had died of this disease).ResultsPeople's preferences were affected by their perceptions and previous experiences of care available at home, in a hospice or hospital. Preferences were also shaped by fears about possible loss of dignity, or fears of becoming a burden. Some people thought that a home death might leave bad memories for other members of the family. People with pancreatic cancer and their relatives were aware that preferences might change (or had changed) as death approached.ConclusionsThe National Health Service End of Life Care Strategy for England seeks to meet the needs of people who are dying and promotes better support for home deaths. More information is needed about why patients hold different views about place of care and place of death, why patients' preferences change and what importance patients attach to place of death. Health professionals should bear this in mind if the subject is raised during advance care planning.

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