Factors Associated with recording a preference for place of death or not. Analysis of routinely collected data from an electronic palliative care coordination system before and during the Covid-19 pandemic

ABSTRACT

BackgroundThe consideration, recording and sharing of where individual patients would prefer to die are core elements of advance care planning and help ensure care is in keeping with patients' wishes.AimTo explore the factors associated with recording a preferred place of death in Coordinate My Care, a large Electronic Palliative Care Coordination System in London.MethodsAdults who created a Coordinate My Care record between 01/01/2018 and 05/03/2021 were included. Multivariate logistic regression modelling was used to identify demographic and clinical factors associated with documenting a preference for place of death, as well as timing (before and during the COVID-19 pandemic) and setting of record creationResults72,591 records were included (52,006 (71.6%) with a recorded preferred place of death and 20,585 (28.4%) without). Individuals with a recorded preferred place of death were more likely to be aged over 80 (compared to <80) OR 1.19, CI 1.14 – 1.24), require assistance for their functional needs (WHO performance status 4 compared to 1, OR 1.28, CI 1.19 – 1.37), have a ‘Do Not Attempt Cardio-Pulmonary Resuscitation' status (OR 1.70, CI 1.60 – 1.80), be from the least deprived areas (compared to most deprived, OR 1.08, CI 1.01 – 1.16), live in a care home (OR1.42, CI 1.35 – 1.50), created their record during the first wave of the pandemic (compared to pre-pandemic OR 1.56, CI 1.49 – 1.63), and create their record in the General Practice setting (compared to at an hospital setting OR 1.42, CI 1.34 – 1.53).ConclusionsPeople's health and socio-economic status, and the COVID-19 pandemic, were associated with recording a preference for place of death. When exploring what matters most to people approaching the end of their lives and providing patient centred end-of-life care, these factors have important implications for patient empowerment and professional training.