The study shows that, according to questionnaires completed by their relatives, those who die at home experience more peace and a similar amount of pain compared to those who die in a hospital, and their relatives also experience less grief. However, this requires discussion of preferences, access to a comprehensive home care package and facilitation of family caregiving.
"Many people with cancer justifiably fear pain,” lead author Barbara Gomes from the Cicely Saunders Institute at King's College London said in a press release. “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."
The new study took place in four health districts in London covering 1.3 million residents. 352 bereaved relatives of cancer patients completed questionnaires after their loved ones’ deaths – 177 patients died in 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 relative's own grief intensity.
The study found that over 91 percent of home deaths could be explained by four factors: patient's preference; relative's preference; receiving home palliative care in the last three months of life, and receiving district/community (hospice care) nursing in the last months of life.
Despite differing trends, the most frequent location of death for cancer patients remains the hospital. In the UK, US and Canada, slightly more appear to be realizing the preference for home, while in Japan, Germany, Greece and Portugal, a trend towards institutionalized dying persists.
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