A population-based study – the most comprehensive of its kind to date – supports the idea that dying at home is beneficial for terminally ill patients. As a charity that aims to enable patients to remain at home throughout their illness, and die at home if that is their wish, Rennie Grove Hospice Care welcomes the findings, which should prompt policymakers to ensure better access to 24/7 specialist nursing and palliative care in patients’ homes.
The study found that patients who die at home experience more peace that those dying in hospital and their relatives experience less grief. Pain relief was equally effective for both sets of patients, with patients dying at home experiencing no more pain than those who died in hospital.
Barbara Gomes, from the Cicely Saunders Institute at King’s College London, UK, was lead author of the study entitled ‘Is dying in hospital better than home in incurable cancer and what factors influence this?’ She explained: “We know that many patients fear being at home, believing they place an awful burden on their family. However, we found that grief was actually less intense for relatives of people who died at home.”
Another element of Gomes et al’s study was the identification of three additional factors previously overlooked: the length of time that the family had been aware that the patient’s prognosis was terminal; whether discussion between the patient and their family about the patient’s preference had taken place and the number of days taken off work by relatives in the three months prior to the patient’s death.
Sue Varvel, Chair of the National Association for Hospice at Home and Rennie Grove’s Director of Nursing & Clinical Services, commented: “These additional factors highlight the importance of the family’s role in enabling patients to stay at home. As well as offering nursing care on a 24/7 responsive basis, Rennie Grove supports the whole family, which can make the different between a patient being able to die at home and having to be admitted to hospital.”
Rennie Grove Hospice Care enables 69% of its patients to die at home, compared with just 22% nationally. Sue adds: “Being just a phone call away at any time of the day or night means that we can quickly get a patient’s symptoms under control before they escalate and necessitate a hospital admission. Many of our senior Hospice at Home nurses can prescribe drugs and can authorise ‘just in case’ medication to be stored at a patient’s home so that pain relief is readily available should their condition deteriorate suddenly.”
Currently around 15% of the cost of Rennie Grove’s services is funded by the NHS. “Obviously there is only a finite reserve of money but we’re hopeful that research like this could encourage statutory funders to increase their contribution,” said Sue. “Keeping patients out of hospital saves the NHS money so funding 24/7 Hospice at Home community services like ours makes sound financial sense as well as delivering what patients want.”