Hospital at home: home-based end of life care

Abstract

Background The policy in a number of countries is to provide people with a terminal illness the choice of dying at home. This policy is supported by surveys indicating that the general public and patients with a terminal illness would prefer to receive end of life care at home. Objectives To determine if providing home-based end of life care reduces the likelihood of dying in hospital and what effect this has on patients’ symptoms, quality of life, health service costs and care givers compared with inpatient hospital or hospice care. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library) to October 2009, Ovid MED-LINE(R) 1950 to March 2011, EMBASE 1980 to October 2009, CINAHL 1982 to October 2009 and EconLit to October 2009. We checked the reference lists of articles identified for potentially relevant articles. Selection criteria Randomised controlled trials, interrupted time series or controlled before and after studies evaluating the effectiveness of home-based end of life care with inpatient hospital or hospice care for people aged 18 years and older. Data collection and analysis Two authors independently extracted data and assessed study quality. We combined the published data for dichotomous outcomes using fixed-effect Mantel-Haenszel meta-analysis. When combining outcome data was not possible we presented the data in narrative summary tables. Main results We included four trials in this review. Those receiving home-based end of life care were statistically significantly more likely to die at home compared with those receiving usual care (RR 1.33, 95% CI 1.14 to 1.55, P = 0.0002; Chi 2 = 1.72, df = 2, P = 0.42, I2 = 0% (three trials; N=652)). We detected no statistically significant differences for functional status (measured by the Barthel Index), psychological well-being or cognitive status, between patients receiving home-based end of life care compared with those receiving standard care (which included inpatient care). Admission to hospital while receiving home-based end of life care varied between trials and this was reflected by high levels of statistically significant heterogeneity in this analysis. There was some evidence of increased patient satisfaction with home-based end of life care, and little evidence of the impact this form of care has on care givers. Authors’ conclusions The evidence included in this review supports the use of end of life home-care programmes for increasing the number of patients who will die at home, although the numbers of patients being admitted to hospital while receiving end of life care should be monitored. Future research should also systematically assess the impact of end of life home care on care givers.

Dying at home – is it better: A narrative appraisal of the state of the science

“…Evidence from systematic reviews suggests home palliative care results in higher caregivers' and patients' satisfaction, 11,12 reduced length of stay in hospitals 11 and greater odds of dying at home. 13,14 However, work is still needed to understand which components of the intervention provide the highest benefit. 11,15 Variations and trends in place of death: international, national and local Many outcomes (e.g.…”

What do we know about different models of providing palliative care? Findings from a systematic review of reviews

“…Evidence for home based palliative care models 10 Three reviews 14,15,16 report specifically on home based models of palliative care for patients with 11 advanced illness, including malignant and non-malignant conditions (Table 2). Positive benefits of 12 palliative home care services over comparator models (which varied) are reported (see Table 2).…”

“…Positive benefits of 12 palliative home care services over comparator models (which varied) are reported (see Table 2). The 13 benefits include an increased likelihood of dying at home, as identified in two meta-analyses 14,16 . 19 Four reviews 21,22,23,24 report on specialised or specialist palliative care, including models of hospice care.…”

DTB Select: 8 | September 2011

“…Many people would prefer to receive end-of-life care at home, if they had appropriate support 1. So, it is notable that a recent Cochrane systematic review has concluded that patients given home-based end-of-life care and support were statistically more likely to die at home rather than in hospital, compared with those receiving usual care.…”