Abstract
BackgroundStudies show that most patients with advanced cancer prefer to die at home. However, not all have equal chances and the evidence is unclear on whether dying at home is better. This study aims to determine the association between place of death, health services used, and pain, feeling at peace, and grief intensity.MethodsMortality follow-back study of 352 cancer patients who died in hospital (n = 177) or at home (n = 175) in London, UK. Bereaved relatives identified from death registrations completed a questionnaire including validated measures of patient’s pain and peace in the last week of life and their own grief intensity. We determined factors influencing death at home, and associations between place of death and pain, peace, and grief.ResultsWhere people died was, for most (80 %), the place where they lived during their last week of life. Four factors explained >91 % of home deaths: patient’s preference, relative’s preference, home palliative care, or district/community nursing. The propensity of death at home also increased when the relative was aware of incurability and the patient discussed his/her preferences with family. Dying in hospital was associated with more hospital days, fewer general practitioner (GP) home visits, and fewer days taken off work by relatives. Adjusting for confounders, patients who died at home experienced similar pain levels but more peace in their last week of life (ordered log odds ratio 0.69, P = 0.007). Grief was less intense for their relatives than for those of patients who died in hospital (β, –0.15 around time of death and –0.14 at questionnaire completion, P = 0.02).ConclusionThe study suggests that dying at home is better than hospital for peace and grief, but requires a discussion of preferences, GP home visits, and relatives to be given time off work.Trial registrationNational Institute of Health Research (NIHR) Clinical Research Network Portfolio. UKCRN7041.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-015-0466-5) contains supplementary material, which is available to authorized users.
Highlights
Studies show that most patients with advanced cancer prefer to die at home
Addington-Hall and Karlsen, in the Regional Study of Care for the Dying (RSCD) in the UK [18], reported higher levels of grief among relatives of patients who died at home, while Wright et al [19], in the Coping with Cancer study in the US, found that relatives of patients who died in hospital were more likely to develop prolonged grief disorder
Based on respondents’ accounts, we found that the level of pain experienced by patients in their last week of life was no different for those who died at home than for those who died in hospital
Summary
Studies show that most patients with advanced cancer prefer to die at home. Studies of patients with advanced cancer and the general public show that most people would prefer to die at home [1, 2]. Tang [20] found that pain was more likely for patients who died at home (compared to hospital), Gomes et al BMC Medicine (2015) 13:235 while Escobar Pinzon et al [21] found the opposite (even when accounting for confounders) and Jordhoy et al [22] found no difference. In an earlier study in London, Parkes [16] had reported worse symptom control for patients who died at home as opposed to hospital
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