The influence of place of death and rural residency on the 'good death'
Date
2017
Authors
Rainsford, Suzanne
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Abstract
Background
Achieving one’s preferred place of death is often considered,
within palliative care, as a proxy for a ‘good death’. To
date, most place of death studies are quantitative and reflect an
urban view. The objectives of this study were to explore the
concept of the good death from the experiences and perspectives
of rural patients with a life limiting illness, and their family
caregivers, within the Snowy Monaro region of New South Wales,
Australia; to determine the influence of place of death and rural
residency on the ‘good death’.
Methods
This thesis was a mixed methods study, comprising
1. Two systematic and one scoping literature reviews, exploring
rural place of death, the rural ‘good death’, and end-of-life
care from the experiences and perspectives of rural patients and
family caregivers.
2. An ethnographic study utilising open ended interviews with 11
rural patients with life limiting illness, 18 family caregivers,
and six clinicians (medical and nursing).
3. A cross-sectional study of cause and place of death for all
people who died in the Snowy Monaro region between 1st February
2015 and 31st May 2016 (N= 224).
Results
Of the 224 deaths recorded, 138 (62%) were due to an illness
amenable to palliative care. Seventeen (12%) of these deaths
occurred at home, in a private residence; 52 (38%) occurred in
the usual place of residence. Residential aged care was
considered home for some residents. Home was the initial
preferred place of death for those interviewed. Over time, dying
in a safe place became more important than dying at home. A
‘safe death’ emerged as the central theme of a ‘good
death’. Home is more than the material structure. It represents
connection to the land, family, and memories, all elements that
underpin its value as a safe place. Rural residency helped
maintain home as a safe place (e.g. privacy on the farm);
however, these same features quickly rendered home an unsafe
place of death (e.g. isolation). The roles of the rural hospital
and rural residential aged care in end-of-life care are unique,
and their familiarity within one’s community often makes them a
safer alternative to home, and a substitute for in-patient
hospice.
Conclusion
Most Snowy Monaro residents do not die at home, yet a ‘good
death’ is achievable. Many elements of the ‘good death’ are
not unique to rural residency; however, rural perspectives on
place of death are often contrary to the urban view. A death at
home does not ensure a good death. The task for all those
providing and supporting end-of-life care is to ensure all places
for dying can deliver the ‘safe death’ no matter where the
illness trajectory dictates that the person dies.
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Keywords
Rural, place of death, good death, palliative care, end of life care, hospice
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Thesis (PhD)
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