• Mary Jane O'Leary, Alison C O'Brien, Marie Murphy, Claire M Crowley, Helen M Leahy, Jill M McCarthy, Joan C Collins, and Tony O'Brien.
• Palliative Medicine, Marymount University Hospital and Hospice, Cork, Ireland.
• BMJ Support Palliat Care. 2017 Mar 1; 7 (1): 53-59.

BackgroundWhile there are many poorly standardised studies focusing on place of death, there are limited data on place(s) of care during the final stages of disease.AimThis study aims to identify where patients are cared for in the interval from referral to specialist palliative care until death.MethodsAll patients who died while under the care of a specialist palliative care service over a 6-month period were considered.ResultsOf the 507 patients included, 255 (50.3%) were men and 428 (84.4%) had a malignant diagnosis. The mean referral-to-death interval was 70 days (SD 113, Range 1-838). The majority (n=281, 55.4%) received care in a single care setting-hospital (28.4%), home (21.5%), nursing home/community hospital (4.1%), hospice (1.4%)-and had a shorter mean referral-to-death interval. Most patients with more than one care setting spent three-quarters of their time in their normal place of residence. A total of 199 (39.3%) died in hospital, 131 (25.8%) in hospice, 131 (25.8%) at home (25.8%) and 46 (9.1%) in a nursing home/community hospital. Patients referred by a general practitioner (n=80 patients, 15.8%) were more likely to be cared for at home (p<0.001), and die at home (p<0.001).ConclusionsA significant number of patients received specialist palliative care across multiple care settings. Late referral is associated with a single domain of care. General practitioner involvement supports patient care and death at home. Place of care and ease of transfer between care settings may be better indicators of the quality of care we provide.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

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