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Dying at home leads to ‘more peace and less grief’

  • 13 Comments

Cancer patients who die at home experience more peace but not more pain that those who die in hospital, according to UK researchers.

However, the benefits are dependent on preferences, access to home care packages and family carers, noted the authors of the study published in the journal BMC Medicine.

Access to specialist palliative care nurses, provided by charities, was also found to be especially key to patients being able to die at home if they wished.

“Our findings prompt clinicians to improve access to comprehensive home care packages including specialist palliative care services and 24/7 community nursing”

Barbara Gomes

Previous studies have shown that most people would prefer to die at home, but the most frequent location of death for cancer patients remains hospital.

Evidence on whether dying at home is better or worse than in hospital has, however, been inconsistent, according to the authors of the new study.

In the study, 352 bereaved relatives of cancer patients from London completed questionnaires after their death – of which 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.

Lead study author Dr Barbara Gomes, from the Cicely Saunders Institute at King’s College London, said the research was the “most comprehensive” population-based study to date of factors and outcomes associated with dying at home compared to hospital.

“The evidence highlights that people with terminal cancer who benefit from having the hands-on care and support of a Marie Curie nurse”

Jane Collins

“We know that many patients fear being at home believing they place an awful burden on their family,” she said. “However, we found that grief was actually less intense for relatives of people who died at home.

“Many people with cancer justifiably fear pain,” she said. “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.”

She added: “They were also reported to have experienced a more peaceful death than those dying in hospital.”

The study found receipt of home palliative care and community nursing support in the last their months of life were key factors leading patients to die at home.

When Marie Curie nurses were involved, the patient rarely died in hospital, the researchers said. The number of general practitioner home visits also increased the odds of dying at home.  

Dr Gomes said the findings should prompt policymakers to “improve access to comprehensive home care packages, including specialist palliative care services and 24/7 community nursing”.

“This is important because, in some regions, the workforce providing essential elements of this care package is being reduced,” she noted.

“We must do everything possible to avoid the all-too-frequent scenario of people at the end of life having an unplanned emergency admission”

Fran Woodard

Dr Jane Collins, chief executive of Marie Curie, said: “The evidence highlights that people with terminal cancer who benefit from having the hands-on care and support of a Marie Curie nurse are less likely to die in hospital, and more likely to die at home, where they want to be.

“Caring for a loved one at home can be a highly distressing time, but with the right care and support in place, this research shows that people’s fears about managing painful symptoms and grief can be alleviated,” she added.

Dr Fran Woodard, executive director of policy and impact at Macmillan Cancer Support, said: “This study provides further evidence of how important it is that people with cancer at the end of life have access to high quality care and support that can ensure they are able to die at home, if they choose.”

“We must do everything possible to avoid the all-too-frequent scenario of people at the end of life having an unplanned emergency admission because of a lack of adequate support at home,” she said. “This increases distress and is a strain on the NHS.”

She highlighted research commissioned by Macmillan showing that 44% of people with terminal cancer relied solely on family and friends for practical support, which she said was “unacceptable”.

  • 13 Comments

Readers' comments (13)

  • michael stone

    Dying seems much more problematic for patients who are, essentially, 'dying from the wear-and-tear of old age' as opposed to from cancer or a single progressive disease, and that problem needs to be sorted out.

    It is very clear that the level of support for patients who are at home, and for their relatives, will have a significant influence on the experience of dying, and on the subsequent bereavement. I've just (less than an hour ago) submitted a second rapid response to a chain on theBMJ discussing place of death and similar, and it will elaborate on that [if the Letters Editor decides to publish it] - the link to the responses, is below.

    The best place for a patient to die, depends in my opinion mainly on the patient's own preference - you can't simply say 'home is better', or 'hospice is the place', or 'hospital is the wrong place' - much too simplistic.

    The BMJ article, and the rapid responses discussing it, are at:

    http://www.bmj.com/content/351/bmj.h4855

    http://www.bmj.com/content/351/bmj.h4855/rapid-responses

    The article in theBMJ is recent, so if anybody wants to send in a rapid response (the article is titled 'Is home always the best and preferred place of death?') to it, there is still time to do that.

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  • Home is cheaper and if sufficient support is given to carers and the individual wants to die at home, ok, but sufficient support must FIRST go to carers.

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  • M stone there are many different reasons for death and not all deaths are predictable and can be planned for! So much for meddling in the clinical side of care that you do not understand!

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  • michael stone

    Anonymous | 10-Oct-2015 8:48 pm

    'M stone there are many different reasons for death and not all deaths are predictable and can be planned for!'

    Quite - that is the point ! Although if you understand that a death is inherently unpredictable, you can allow for that uncertainty within your planning:

    http://www.bmj.com/content/350/bmj.h3181/rr-2

    Where I pointed out:

    ' at the moment behaviour sets
    for EoL home death seem to assume an 'idealised model' which is very different
    from the reality of many EoL home deaths. The guidance and protocols, should be
    based on the reality of EoL at home, accepting the many complications, and not on 'a guidance-writers' wish-list of how EoL at home should work in a 'perfect and
    much-simplified world''.'

    It is why I'm so angry, about contemporary behaviour for End-of-Life Home Death:

    http://www.dignityincare.org.uk/Discuss_and_debate/Discussion_forum/?obj=viewThread&threadID=785&forumID=45



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  • 'Quite - that is the point ! Although if you understand that a death is inherently unpredictable, you can allow for that uncertainty within your planning:'

    ha, ha very clever when a patient is bought to you on an acute busy ward and dies unexpectedly a few hours later!!!!!!!!


    found that comic yet?

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  • michael stone

    Anonymous | 11-Oct-2015 4:28 pm

    I write about known end-of-life, and the uncertainty associated with exactly when a patient will die: there is a serious issue with 'earlier than anticipated but known EoL deaths at home' (where EoL means 'predicted to be within the final year of life).

    Your patient on the acute ward, is probably not part of my 'issues' - and there is very little about death which is 'comic'.

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  • stone, I am interested in what I write based on years of extensive professional experience, not in what you write.



    I didn't suggest death is comic but just that a comic would be a more suitable media for your commentary. you seem to confound nouns with adjectives in your reading.

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  • michael stone

    Anonymous | 12-Oct-2015 5:33 pm

    I had forgotten your previous suggestion that I should be writing in comics, when I was reading and responding to your piece above - my memory might work better, if more people on this website posted with a username instead of anonymously.

    Being interested in your own writing [as opposed to be trying to clear in it] seems to me to be a strange position.

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  • michael stone | 13-Oct-2015 10:29 am

    I wondered what the long delay was over the comics!



    you were even pointed in the right direction of a serious EOLC professional journal but of course like everything else you poo-pooed that as well.



    Have you never noticed the 'Post as' choices under each empty comment space? it is absolutely none of your business which choice others make.


    Clear Off! you have nothing to say here.


    How many publications have you listed on the international professional data bases - and all of mine under my own name!

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  • michael stone

    Anonymous | 14-Oct-2015 10:18 am

    I don't recall off-hand the serious professional EOLC journal you mentioned - but if I saw the comment, I probably checked it out.

    I don't think I contribute to 'data bases', but I post here under my own name, and I post under my own name on BMJ, Marie Curie and Dignity In Care - I invariably comment with my name, if websites allow that.

    All I wrote, is that MY memory would probably function better re recalling comments, if there was a username present - I never said people cannot post anonymously [although I've never really understood why anyone would chose to regularly do so, given the option of posting under an 'alias' on this website].

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  • Dying costs far more at home than in hospital according to a medical ethicist interviewed on TVs last evening and must be carefully thought through and planned for. The final decision remains with the patient alone and most chose, and often prefer, to die in hospital to relieve the burden on their families.

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  • Mstone

    You don't contribute to data bases, they select you published work if it has some value! Posting a comment is not publishing and attracts little attention.

    Why people chose to comment anonymously is entirely their own business. Memory problems are your own concern.

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  • Back to the subject of dying at home… I query the accuracy of the belief that dying at home costs more.

    Buurtzorg healthcare model seems to suggest otherwise, I believe, though I'm not entirely sure about that.

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