Introduction The Scottish government “Living and Dying Well” action plan aims to ensure that end of life care needs are recognised in all care settings. This study aims to examine end of life care for Upper GI cancer patients, diagnosed within the geographically diverse region that comprises NHS Highland. Following diagnosis, do we get patients home, and do they die at home?
Methods E-Case Cancer Audit, Cancer Waiting Times Submissions, General Register Office Death and Cancer Registry databases were searched using ICD10 codes for upper GI cancer (ICD10 C15–C17 and C22–C25) for years 2005–2010. Place of death for patients diagnosed within NHS Highland was identified and recorded as one of: home, hospital, hospice or “other institution”. This data were then compared with Scottish national data for all cancers, compiled and published by Information Services Division, Scotland.
Results 978 patients were diagnosed with upper GI cancer in the study period. Place of death was not known in 298 patients and these were therefore excluded from further analysis. Of the remaining 680 patients 237 (34.9%) died at home, 295 (43.4%) died in hospital, 96 (14.1%) died in hospice and 49 (7.2%) died in another institution. Of 75 522 cancer deaths in Scotland between 2004 and 2008 24.3% died at home, 51.9% died in hospital, 17.6% died in hospice and 6.2% died in another institution. Using χ2 testing with Yates' correction, differences between NHS Highland and national data show highly significant differences in both “at home” and “in hospital” deaths (p<0.0001).
Conclusion Despite government initiatives, over half of cancer patients in Scotland still die in hospital and just under a quarter die at home. In our study group fewer patients die in hospital and more—over one third—die at home. Despite the challenges of geography and transport links in the north of Scotland, the ability to deliver complex care and end of life planning for patients with Upper GI cancer is not adversely affected.
Competing interests None declared.
Reference 1. Information Services Division. Living and Dying Well: A National Action Plan For Palliative And End Of Life Care In Scotland. Scotland: NHS National Services, 2008. http://www isdscotland.org. ISBN 9780755958894.
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