Dying at Home: Pros and Cons
Dying at home could be beneficial for terminally ill cancer patients and their relatives, according to research published in October 2015 in the open-access journal BMC Medicine. On the other hand, an article published the same week in the British Medical Journal (BMJ) contends that home is not always the best or preferred place to die.
The BMC study shows that according to questionnaires completed by their relatives, those who die at home experience more peace and a similar amount of pain compared to those who die in hospital, and their relatives also experience less grief. However, this requires discussion of preferences, access to a comprehensive home care package, and facilitation of family caregiving.
Previous studies have shown that most people would prefer to die at home. In the UK, US and Canada, slightly more appear to be realizing this wish, while in Japan, Germany, Greece and Portugal, a trend towards institutionalized dying persists.
Despite differing trends, the most frequent location of death for cancer patients remains hospital. Evidence regarding whether dying at home is better or worse than in hospital has, however, been inconsistent.
The BMC study took place in four health districts in London covering 1.3 million residents. 352 bereaved relatives of cancer patients completed questionnaires after their death – 177 patients died in hospital and 175 died at home. The questionnaires included validated measures of the patient’s pain and peace in the last week of life and the relative’s own grief intensity.
A release from the publisher quotes lead author Barbara Gomes from the Cicely Saunders Institute at King’s College London, UK as saying, “This is the most comprehensive population-based study to date of factors and outcomes associated with dying at home compared to hospital. We know that many patients fear being at home believing they place an awful burden on their family. However, we found that grief was actually less intense for relatives of people who died at home.
“Many people with cancer justifiably fear pain. So it is encouraging that we observed patients dying at home did not experience greater pain than those in hospitals where access to pain relieving drugs may be more plentiful. They were also reported to have experienced a more peaceful death than those dying in hospital.”
The study found that over 91% of home deaths could be explained by four factors: patient’s preference; relative’s preference; receipt of home palliative care in the last three months of life and receipt of district/community nursing in the last their months of life. When Marie Curie nurses (which provide additional home support) were involved, the patient rarely died in hospital. The number of general practitioner home visits also increases the odds of dying at home.