Where do people prefer to die?
The National Bereavement Survey (VOICES), run by the Office for National Statistics, asks respondents about the end of life care their family member or friend received in their last three months. Findings from the second VOICES survey were recently published (ONS, 2013a), and support other research reporting that dying at home is the most common preference. About 80% of those who had expressed a preference stated their own home was their preferred place to die but only half of these actually died at home (49%). In England, hospital is the most common place of death (52%).
Does cause of death vary with place of death?
The cause of death varied by place of death, with cancer deaths being the most common cause for those who died at home or in a hospice. Deaths where the underlying cause was not cancer more commonly occurred in hospitals or care homes.
Figure 1: Place of death by cause of death for the survey sample, England, 2012
Does quality of care vary by cause and place of death?
The VOICES survey also asks relatives about the quality of care received in the last three months of life. Quality of care rated as Outstanding or Excellent was most commonly given for those who died of cancer at home. The overall quality of care for those who died in hospital was least likely to receive an Outstanding or Excellent rating, irrespective of cause of death.
Figure 2: Overall quality of care across all settings rated as outstanding or excellent: by cause of death and place of death, England, 2012
However, not all aspects of care were rated highly for those at home. Where it was relevant, relief of pain was reported as being provided ‘completely, all of the time’ most frequently in hospices (63%) and least frequently at home (19%). A recent survey showed that while dying at home was a top preference and dying without pain and discomfort was a top priority, people would still opt to die at home while recognising that pain relief may not be optimal (Wood & Salter, 2013).
Does support to remain at home vary across England?
The presence of family or informal carers is important if people are to remain at home to die. Good community services are also important. However, findings from the first VOICES survey showed that quality of care from community services varied across the country (ONS, 2012), and was poorest in the most deprived areas (ONS, 2013b). For example, for those who spent some or all of their last three months at home, the reported quality of care from GPs varied with how deprived the area was. According to findings from the first VOICES survey, Excellent quality of care was rated by 37% of respondents whose relative or friend lived in the least deprived areas compared with 30% in the most deprived areas (ONS, 2013b).
What is the National Bereavement Survey (VOICES)?
The National Bereavement Survey (VOICES) is a national survey across England to measure the quality of end of life care. This survey, run by the Office for National Statistics, uses the VOICES-SF questionnaire: the Views of Informal Carers – Evaluation of Services (VOICES). For the first VOICES survey, ONS mailed out the questionnaires in the autumn of 2011 and the second VOICES survey in the autumn of 2012. For each survey, questionnaires were sent to about 50,000 people across England who had experienced a bereavement between four and 11 months previously. Both surveys achieved a response rate of 46% which compares favourably with other surveys of this type.
Office for National Statistics (2012) National Bereavement Survey (VOICES) by PCT Clusters, 2011
Office for National Statistics (2013a) National Bereavement Survey (VOICES), 2012
Office for National Statistics (2013b) National Bereavement Survey (VOICES) by Area Deprivation, 2011
Wood C, Salter J. (2013) A time and a place: what people want at the end of life. Sue Ryder.
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