Dying at Home: A Literature Review (741)

Abstract

1.Describe important empirically driven components of dying at home.2.Discuss complicated meanings for patients, caregivers and providers of dying at home. Background. Dying at home may have initially been introduced as a response to misguided and poor care of dying patients in hospitals. However, the significant increase in place of death for hospice patients in inpatient settings versus private residences suggests that dying at home is a concept needing reclarification and evaluation. Research objectives. The purpose of this review was to develop a literature-based definition of the concept “dying at home” that could be used as a conceptual framework to guide further research. Methods. Three electronic databases (ie, CINAHL, PubMed, and PsychINFO) were searched with restriction to English language, humans, and older adults (age greater than 65 years) for dying or death and home nursing or home care services or hospice care. Overall, 405 abstracts were collected; abstracts were reviewed for saliency and criteria for inclusion was a focus on location of care of the dying at home, explication of the meaning of dying at home, and a data based publication. A total of 35 articles met the criteria. Content was analyzed and integrated into the final framework. Results. Major themes identified in these articles included predictors of place of death, multiple meanings of being “at home,” expressed end-of-life preferences, transitions, and caregiver involvement. A preliminary framework focused on dying at home was elucidated and included adequate resources, a physical location of care, patient preference, caregiver preference, awareness of prognosis, caregiver support, a time-limited course, access to symptom management and feeling “at home.” Conclusion. Dying at home is a multi-layered, complex concept for patients, caregivers, and providers influenced by many factors. A more cautious view of dying at home as a gold standard should be considered for future hospice policy discussions. Implications for research, policy, or practice. Clinically relevant research in this area calls for a better understanding of needs, appropriateness, and evaluation of the role of dying at home in patient and caregiver outcomes.