Abstract
BackgroundStudies have shown that more than half of patients with advanced progressive diseases approaching the end-of-life report pain and that pain relief for these patients is poorest at home compared to other care settings such as acute care facilities and hospice. Although home is the most common preferred place of death, the majority of deaths occur outside the home. Specialist palliative care is associated with improved quality of life, but systematic reviews of RCTs have failed to show a consistent association with better pain relief. The aim of this study was to examine the factors associated with good pain relief at home in the last 3 months of life for people with advanced progressive disease.MethodsData were obtained from the National Bereavement Survey in England, a cross-sectional post-bereavement survey of a stratified random sample of 246,763 deaths which were registered in England from 2011 to 2015. From 110,311 completed surveys (45% response rate), the analysis was based on individual-level data from 43,509 decedents who were cared for at home before death.ResultsDecedents who experienced good pain relief at home before death were significantly more likely to have received specialist palliative care (adjusted OR = 2.67; 95% CI, 2.62 to 2.72) and to have a recorded preferred place of death (adjusted OR = 1.87; 95% CI, 1.84 to 1.90) compared to those who did not. Good pain relief was more likely to be reported by a spouse or partner of the decedents compared to reports from their son or daughter (adjusted OR = 1.50, 95% CI, 1.47 to 1.53).ConclusionThis study indicates that patients at home who are approaching the end-of-life experience substantially better pain relief if they receive specialist palliative care and their preferred place of death is recorded regardless of their disease aetiology.
Highlights
Pain is a highly prevalent and debilitating problem among people with advanced progressive disease [1, 2]
This is supported by evidence from the National Survey of Bereaved People (VOICES) in England which showed that pain relief is poorest for people who received end-of-life care at home compared to those dying in acute care facilities or hospice [14]
We aimed to examine the factors associated with good pain relief at home in the last 3 months of life for people with advanced progressive illness
Summary
Pain is a highly prevalent and debilitating problem among people with advanced progressive disease [1, 2]. Numerous studies have consistently shown a mismatch between expressed preferences for place of death and actual place of death with most people preferring to die at home but the majority dying in hospital [10, 11] Issues such as carer burden or difficulties in controlling pain and other symptoms at home make the majority of deaths occur outside the home [12, 13]. Studies have shown that more than half of patients with advanced progressive diseases approaching the end-of-life report pain and that pain relief for these patients is poorest at home compared to other care settings such as acute care facilities and hospice. The aim of this study was to examine the factors associated with good pain relief at home in the last 3 months of life for people with advanced progressive disease
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