Synopsis
Elicit and revisit preferences for care and death, distinguish aspiration from a guaranteed outcome, and coordinate people, equipment, medicines, funding, transport and contingency support so that the chosen setting remains safe and achievable.
- Ask separately where the person would prefer routine care, crisis care and death; these answers may differ and can change over time.
- Preference is an important goal, not a promise. Explain uncertainty and the practical conditions required without making the person feel responsible for service limitations.
- First-line feasibility assessment covers symptom complexity, mobility, cognition, medication route, equipment, overnight help, caregiver willingness, housing and emergency access.
Key red flags
A stated wish for home does not authorise discharge when essential care, oxygen, equipment, medicines or a safe receiving person are unavailable.
The supporting person's exhaustion, fear, illness or withdrawal of consent can make continued home care unsafe despite the patient's preference.
Investigation priorities
Ask preferred settings for current care, future crisis and death and understand which valued features drive each preference.
Management branches
The person identifies a preferred place for ongoing care or death.
- Explore what the setting means, assess capacity and record separate preferences for stable care, crisis and dying with any conditions attached.
- Map clinical, functional, social, housing, equipment, funding and caregiver requirements and assign each gap to a responsible service.
A deteriorating inpatient wants transfer and delay may remove the opportunity to reach the preferred setting.