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”
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”
“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”
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”.