People with terminal conditions should be able to die at home with dignity

People with terminal conditions should be able to die at home with dignity, say researchers in this week's BMJ.

Although 65% of people with cancer want to die at home, only about 30% are successful in doing so. A government committed to choice for patients must improve this figure, write palliative care experts from Edinburgh University.

Developing palliative care services in primary care is essential for realising the expectations of dying people. Primary care professionals have the potential and ability to provide end of life care for most patients, given adequate training and resources. However, until recently, few comprehensive workforce initiatives have been undertaken in primary care that focus on end of life care.

Furthermore, the new general medical services contract has not prioritised palliative care. These changes will greatly affect care for dying people and may increase the number of hospital admissions, they add.

However, one important initiative is gaining momentum within primary care. The Gold Standards Framework is a resource for organising proactive palliative care in the community. It includes a detailed guide to providing holistic, patient centred care and thereby facilitates effective care in the community.

Every person with a progressive illness has a right to palliative care, say the authors. General practitioners and community nurses are trusted by patients and are in a position to provide effective, equitable, and accessible palliative care. This will happen only if they have adequate time and resources and work in a system that encourages such care.

Patients who receive holistic support in the community may be less likely to require expensive admission to hospital and often futile treatments at the end of their lives, they conclude.