Palliative home care doubles chances of dying at home

Categories: Research.

The review, published this week in the Cochrane Library, pulled together the findings of all known studies that evaluated home palliative care services, and included data from the UK, USA, Sweden, Norway, Italy, Spain, Canada and Australia. 

It was led by researchers from the Cicely Saunders Institute at King’s College London, in collaboration with the King’s Centre for the Economics of Mental and Physical Health and at the geriatrics unit of the Princess Grace Hospital in Monaco.

As well as confirming that receiving palliative care at home increases the odds of dying at home (the prefered place of death for the majority of people) the researchers also calculated that, for one additional patient to die at home, five patients would need to receive home palliative care.

However, the researchers found a number of areas where evidence was conflicting or inconclusive. There was conflicting evidence on the impact of home palliative care on specific symptoms such as pain, breathlessness and sleep disturbance.

Evidence on the cost-effectiveness of home palliative care was also inconclusive.

Dr Barbara Gomes, who led the study, said: “These are important findings as they show for the first time clear and reliable evidence of benefits that justify the provision of home palliative care to allow more people to die at home and to reduce patients’ symptom burden.

“Home palliative care is key to narrowing the gap between where people wish to die and where they actually die, which we know exists in many countries – the research shows these services work. Their development must therefore be central in national strategies to improve the care people receive towards the end of their life. There are countries where these services barely exist. For example, in Portugal there are currently only nine to fourteen home palliative care teams for a population of 10 million inhabitants.”

Professor Irene J Higginson, Director of the Cicely Saunders Institute, added: “This review shows the need to provide specialist, dedicated home palliative care services to provide an additional layer of individualised support for people reaching the end of life, and their families. Specialist care teams should work with existing services, and people with progressive and far advanced illness or their families should be able to ask for these services, which should be made available where they are lacking.”

The authors of the review have also published a briefing, which makes a number of policy recommendations:

  • Invest in home palliative care services – this could mean start investing, continuing to invest or reconsidering plans of withdrawing funding from these services.
  • Include home palliative care development in national health policies and strategies – to ensure that people who wish to die at home do so with the best possible care. 
  • Apply findings to your local population in order to plan future home palliative care – policy makers and health services planners can use their local mortality statistics to help calculate what home death rate would be achieved if all people who are dying received home palliative care.

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