What characterises good home-based end-of-life care: Analysis of 5-year data from a nationwide mortality follow-back survey in England

Aim: To determine what characterises good quality end-of-life care for home-dwelling patients. Design and setting: An observational study using 5-year data from the National Survey of Bereaved People (VOICES). Methods: Analysis was based on 63,598 decedents who were cared for at home in the last three months of life, drawn from 110,311 completed mortality follow-back surveys of a stratified sample of 246,763 deaths registered in England between 2011 and 2015. Logistic regression analyses were used to identify independent variables associated with overall quality of end-of-life care and other indicators of quality of end-of-life care. Results: Patients who received good continuity of primary care (adjusted OR = 2.03; 95% CI, 2.01 to2.06) and palliative care support (adjusted OR = 1.86; 95% CI, 1.84 to 1.86) experienced better overall quality of end-of-life care as perceived by relatives. Decedents who died from cancer or died outside hospital were more likely to receive good end-of-life care as perceived by relatives. Being older and female, from the least socio-economic deprived areas and being white were associated with better overall end-of-life care as perceived by relatives. Conclusion: Good continuity of primary care was associated with better quality of end-of-life care. Improved end-of-life care was also associated with specialist palliative care support and death outside of hospital. Disparities still exist for those from minority ethnic groups and living in areas of socio-economic deprivation. Future commissioning and initiatives must consider these variables to provide a more equitable service.