Dying at Home Linked to More Peace, Less Grief

For terminally ill cancer patients, dying at home may result in a more peaceful death and less grief for loved ones, according to a new study published in the journal BMC Medicine.

“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,” said lead author Barbara Gomes, Ph.D., from the Cicely Saunders Institute at King’s College London, UK.

The findings also show that cancer patients who died at home experienced a similar amount of pain to those who die in hospital.

“Many people with cancer justifiably fear pain. So it is encouraging that we observed patients dying at home did not experience greater pain than those in hospitals where access to pain relieving drugs may be more plentiful. They were also reported to have experienced a more peaceful death than those dying in hospital,” said Gomes.

Prior research has shown that most people would prefer to die at home. In the U.K., U.S., and Canada, slightly more appear to be passing away at home, while in Japan, Germany, Greece, and Portugal, a trend towards institutionalized dying persists.

Despite differing trends, the most frequent location of death for cancer patients is still at the hospital. Evidence regarding whether dying at home is better or worse than in the hospital has been inconsistent.

For the study, a total of 352 bereaved relatives of cancer patients in London completed questionnaires after their death — 177 patients died in the hospital and 175 died at home. The questionnaires included validated measures of the patient’s pain and peace in the last week of life and the family member’s own grief intensity.

“Our findings prompt policymakers and clinicians to improve access to comprehensive home care packages including specialist palliative care services and 24/7 community nursing. This is important because, in some regions, the workforce providing essential elements of this care package is being reduced,” said Gomes.

The researchers also highlight the crucial role of families in caring for patients at home and in decision-making processes, and the need to facilitate family caregiving.

“Many relatives see dedicated care as something they would naturally do for their loved one, but it still represents out-of-pocket money or days off their annual leave. Some governments, for example, in Canada, the Netherlands, Norway, and Sweden, have set up social programs or employment insurance benefits, similar to maternity leave, aimed at supporting families to provide care for their dying relatives,” said Gomes.

“We urge consideration of similar schemes where they do not exist, with the necessary caution associated with complex public health interventions — careful development, piloting and testing, prior to implementation.”

Source: BioMed Central