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Home palliative care a key to respecting end of life wishes

The Bottom Line

  • People who are nearing the end of their lives often prefer to be cared for and to die in their own homes.
  • Home palliative care – provided by specially trained health professionals – makes it possible to fulfill such wishes while offering help and support to the patients’ family caregivers.
  • Studies show that home palliative care increases the likelihood of the patient dying at home and may help ease symptoms slightly. 

Although it’s something we all do at some point, the topic of dying has traditionally been a difficult and uncomfortable one to discuss. That’s changing as people understand and embrace the objectives of end of life and palliative care: addressing physical, emotional and spiritual needs, maximizing quality of life and helping satisfy individuals’ desires and preferences - including how and where they want to spend their final days and where they want to die.  

For the majority of people (well over 50% according to recent research) that means being cared for, and dying, in their own homes (1;2). Home palliative care services make it possible to respect those wishes, while ensuring patients in the advanced stage of an illness – and their family caregivers – receive the help and support they need.  

A well-done systematic review of relevant studies attempted to determine whether home palliative care does actually increase the chance of patients dying at home (2). The review also explored related questions, such as whether home palliative care services helped improve management of symptoms and quality of life for the patient and reduced distress in family caregivers.  

A total of 23 studies, including 16 randomized controlled trials, involved more than 37,500 patients (mean age ranged from 53 to 77) and more than 4,000 family caregivers (primarily spouses of the patients). Care was provided by teams of two to 13 health professionals including doctors, nurses and social workers specializing in palliative care and end of life treatment. In some cases, caregiver support was provided.  

What the research tells us

There is strong evidence that compared with usual care (i.e in hospitals, hospices and nursing homes), home palliative care increases the likelihood of a patient dying at home (3;4). It also helps to reduce suffering caused by symptoms by a small degree (3).  

Home palliative care did not have any significant impact on caregivers’ grief in the first 13 months following their loved one’s death (3). There was not enough evidence to draw conclusions about quality of life or the effects on caregiver burden (3;4).  

Further research is warranted, including additional investigation into the cost-effectiveness of services. Meanwhile home palliative care offers important benefits and appears to be an alternative option for patients, their families and caregivers whose end of life wishes include dying at home.  

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Author Details

References

  1. Gomes B, Calanzani N, Gysels M, et al. Heterogeneity and changes in preferences for dying at home: A systematic review. BMC Palliat Care. 2013; 12:7.  
  2. Bell CL, Somogyi-Zalud E, Masaki KH. Methodological review: Measured and reported congruence between preferred and actual place of death. Palliat Med. 2009; 23:482-90.
  3. Gomes B, Calanzani N, Curiale V, et al. Effectiveness and cost-effectiveness of home palliative care services for adults with advanced illness and their caregivers. Cochrane Database Syst Rev. 2013; 6:CD007760.
  4. Shepperd S, Goncalves-Bradley DC, Straus SE, et al. Hospital at home: Home-based end-of-life care. Cochrane Database Syst Rev. 2016; 2:CD009231. doi: 10.1002/14651858.CD009231.pub2. 

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