Beecham, E

Bluebond-Langner, M

Candy, B

Jones, L

Langner, R

M. Bluebond-Langner

E. Beecham

B. Candy

R. Langner

L. Jones

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Problems with preference and place of death for children too

UCL Discovery

PLACE OF DEATHProblems with preference and place of death forchildren tooMyra Bluebond-Langner professor and True Colours chair in palliative care for children and youngpeople 1, Emma Beecham research associate 2, Bridget Candy senior research associate 2, RichardLangner honorary senior research associate 1, Louise Jones senior clinical lecturer 21Louis Dundas Centre for Children’s Palliative Care, UCL-Institute of Child Health, London WC1N 1EH, UK; 2Marie Curie Palliative Care ResearchUnit, UCL Mental Health Sciences Unit, University College Medical School, London, UKThe problems raised by Pollock about preference and place ofdeath also apply to seriously ill children, even though choicesabout care are made with or by a person other than the patientand children typically have one or more devoted carer.1 Oursystematic review of empirical research on preference for placeof death for seriously ill children found, as Pollock does foradults, a lack of evidence for the oft repeated claim that mostparents and children would prefer home as the place of death.2Other problems are that preferences change over the course ofillness, some people delay or do not wish to express apreference, and some children die without a conscious choiceof location having been made.The proportion of seriously ill children who die at home or whoattain a preference for place of death is not a useful outcomemeasure; neither reliably reflects the success of a team or of asystem to provide quality healthcare or a good death. Perhapswhat is most important for seriously ill children and theirfamilies is to have some discussion about priorities and optionsfor current and future care, rather than to have made a particularchoice3—one that is not easily taken in the face of oftenuncertain and changing circumstances.Competing interests: None declared.1 Pollock K. Is home always the best and preferred place of death? BMJ 2015;351:h4855.(7 October.)2 Bluebond-Langner M, Beecham E, Candy B, et al. Preferred place of death for childrenand young people with life-limiting and life-threatening conditions: a systematic review ofthe literature and recommendations for future inquiry and policy. Palliat Med2013;27:705-13.3 Dussel V, Kreicbergs U, Hilden JM, et al. Looking beyond where children die: determinantsand effects of planning a child’s location of death. J Pain SymptomManage 2009;37:33-43.Cite this as: BMJ 2015;351:h6123© BMJ Publishing Group Ltd 2015bluebond@ucl.ac.ukFor personal use only: See rights and reprints http://www.bmj.com/permissions Subscribe: http://www.bmj.com/subscribeBMJ 2015;351:h6123 doi: 10.1136/bmj.h6123 (Published 19 November 2015) Page 1 of 1LettersLETTERS

Problems with preference and place of death for children too.

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Problems with preference and place of death for children too.

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