October 25, 2021

I, Science

The science magazine of Imperial College

Iona Twaddell looks at research into inequalities in end-of-life care

he doesnt want to see this picture 442372023_67a0e78230_oI don’t when, where or how I’m going to die. But I know I would like a good death. I would like to die somewhere where nurses and doctors know how to make me feel as comfortable as possible. This may mean dying in a hospice. Sadly, this is becoming an option only for people in affluent areas: death is seemingly no barrier to inequality.

With an ageing population, living longer with complex conditions such as cancer or dementia, more people are dying in hospices than ever before, according to a team from King’s College London that recently analysed every hospice death in England since 1993. This number is only going to increase. But you are much more likely to die in a hospice if you live in an affluent area than a deprived area, and this gap is widening.

There are many possible reasons for the disparity. One is geographic: most hospices are charities, and as Dr Katherine Sleeman, one of the study’s authors says, “Because hospices have relied on fundraising, a lot of them sprung up in leafy well-to-do suburbs.” But attitudes might also be a factor: people in poorer areas may believe hospices are not for them, or aren’t aware of their existence. Deprivation affects how we die as well as how we live.where we die graph2How can we tackle this inequality? In other areas of healthcare education and awareness initiatives have been effective in reducing disparities. These interventions work. We just need to use them. But we do not like to talk about death. And we do not like to fund research about it either. Only 10p out of every £100 spent on medical research finds its way to research into end of life care.

As the population gets older, we need new research to address whether the current hospice model is the way forward. The study found that only 6% of people die in hospices. As Dr Sleeman says, “We cannot rely on the hospice sector to look after all our dying… Resources are finite so there’s going to have to be a compromise.” This may mean re-allocating funding to services that reach as many people as possible in their own homes, but without the research we just don’t know.

I know I want a good death, whatever that means. What concerns me is that nobody seems to know the best way to make this a reality for everyone.

Iona Twaddell is studying for an MSc in Science Communication

Images: He doesn’t want to see this picture… by Kelly Sue DeConnickGovernment funding supports Oceanside Hospice Society, by Province of British Columbia (Flickr, Creative Commons)

Citation: Sleeman, K.E. et al (2015) The changing demographics of inpatient hospice death: Population-based cross-sectional study in England, 1993–2012. Palliat Med. doi: 10.1177/0269216315585064

Graph data taken from: Gomes B (2012) Reversal of the British trends in place of death: time series analysis 2004-2010 Palliat Med. 26:102-7. doi: 10.1177/0269216311432329