Patients who die at home have better quality of life

Abstract

A study by the Dana-Farber Cancer Institute in Boston, Massachusetts, found that cancer patients who die in the hospital have worse quality of life than those who die at home.1 In addition, their caregivers are at higher risk for developing psychiatric illness during bereavement. The research also noted that bereaved caregivers of patients who died in the intensive care unit (ICU) were 5 times more likely to be diagnosed with post-traumatic stress disorder (PTSD) than caregivers of patients who died at home with hospice care. In addition, families and loved ones of patients who died in the hospital (although not in an ICU) were at higher risk of developing prolonged grief disorder (PGD), an intense and disabling form of grief that lasts more than 6 months. The authors include Alex Wright, MD, a medical oncologist and outcomes researcher at Dana-Farber Cancer Institute, and Holly Prigerson, PhD, director of Dana-Farber's Center for Psycho-oncology and Palliative Care Research and senior author of the paper. They noted that although most cancer patients prefer to spend their final days at home, 36% die in a hospital, and 8% die in an ICU. During the time they are hospitalized, they may undergo invasive and painful procedures. The ICU can be traumatic for patients and families in contrast to home or hospice care that emphasizes relieving pain and discomfort and enables a peaceful death. The findings were from a prospective, longitudinal study of advanced cancer patients recruited between 2002 and 2008. Patients and caregivers, mainly family members, were interviewed at the beginning of the study. Their medical charts were reviewed at that point and after the patients died, on average about 4.5 months later. Researchers interviewed the most closely involved caregiver within 2 weeks of the death and again 6 months later. Caregivers were asked to assess their patient's quality of life and physical and psychological stress during the last week of life. Upon review of 342 patient-caregiver pairs, investigators found that patients who died in the hospital or an ICU experienced more physical and emotional distress than those who died at home. Four of 19 (21%) caregivers of patients dying in an ICU developed PTSD compared with 6 of 137 (4.4%) when death occurred in the home or hospice setting. Caregivers of patients dying in the hospital, but not the ICU, experienced a high risk of prolonged grief disorder. “If patients are aware that more aggressive care may affect not only their quality of life but also their loved ones after their death, they may make different choices;” Dr. Wright noted in a Dana-Farber Cancer Institute news release.