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In people with advanced illness, home palliative care increases likelihood of dying at home

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.

Review questions

In people with advanced illness, do home palliative care services increase the likelihood of dying at home and improve symptoms and quality of life? Do home palliative care services reduce distress in family caregivers?

Background

Many people with advanced illness wish to receive palliative care at home rather than in a hospital or hospice. Some people also prefer to die at home. They are concerned about adequate control of their symptoms, quality of life, and minimizing the distress of their family caregivers.

Home palliative care is for people with advanced illness, who are no longer responding to usual treatments. The aim is to support patients and their family caregivers outside of hospital or institutional settings to allow patients to stay at home. Care is provided by a team of specially trained doctors, nurses, and other health professionals and focuses on several aspects of both physical and psychosocial care (e.g., pain control, physiotherapy, emotional support).

How the review was done

The researchers did a systematic review, based on studies available up to November 2012.

They found 23 studies, including 16 randomized controlled trials, with 37,561 people (about half women, average age 53 to 77 years) and 4,042 family caregivers (average age 56 to 63 years).

In the studies, most people had cancer; others had illnesses such as multiple sclerosis, congestive heart failure, chronic obstructive pulmonary disease (emphysema or chronic bronchitis), or AIDS.

Caregivers were usually husbands or wives.

Home palliative care was usually provided by teams of 2 to 13 professionals including doctors, nurses, and social workers. Sometimes, caregiver support was provided. The types and features of care provided varied widely.

Home palliative care was compared with usual care, which varied widely.

What the researchers found

Strong evidence showed that compared with usual care, home palliative care:

  • increased the likelihood of dying at home by about 21%, from 34% to 55%;
  • reduced symptom burden by a small amount; and
  • did not affect caregiver grief in the first 13 months after the person’s death.

Evidence was conflicting or inconclusive for the outcomes of pain, physical function, quality of life, caregiver burden, and caregiver satisfaction with care.

Conclusions

In people with advanced illness, home palliative care increases the likelihood of dying at home and reduces symptom burden, but the effects on pain, physical function, and quality of life are unclear. Home palliative care does not reduce grief for caregivers, and the effects on caregiver burden and satisfaction with care are unclear.

Home palliative care vs usual care in people with advanced illness*

Outcomes

Number of studies (people)

Rate of events with home palliative care

Rate of events with usual care

Absolute effect of home palliative care

Dying at home

7 studies (1,222 people)

55%

34%

About 21 more people out of 100 died at home

Symptom burden

4 studies (2,107 people)

Reduced symptom burden by a small amount

Caregiver grief in the 13 months after death

4 studies (2,113 people)

No effect

*These results are based on studies with strong evidence.




Glossary

Randomized controlled trials
Studies where people are assigned to one of the treatments purely by chance.
Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.

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