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Oct 09, 2015 06:53 PM EDT

Dying At Home May Lead To More Peace, Less Grief

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New research suggests that dying at home could be beneficial for terminally ill cancer patients and their relatives.

Researchers found that those who die at home experience more peace and a similar amount of pain compared to those who die in 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.

"This is the most comprehensive population-based study to date of factors and outcomes associated with dying at home compared to hospital. 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," Barbara Gomes, lead author of the study, said in a statement. "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."

For the study, researchers collected and analyzed data from 1.3 residents living in four health districts in London.  Three Hundred fifty-two bereaved relatives of cancer patients completed questionnaires after their death -- 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.

They found that more than 91 percent of home deaths could be explained by four factors: patient's preference; relative's preference; receipt of home palliative care in the last three months of life and receipt of district/community nursing in the last their months of life. When Marie Curie nurses (which provide additional home support) were involved, the patient rarely died in hospital. The number of general practitioner home visits also increases the odds of dying at home.

Three additional factors were also identified that had been previously overlooked -- length of family's awareness of that the condition could not be cured, discussion of patient's preference with family, and the days taken off work by relatives in the three months before death. The authors say this challenges current thinking about the influence of patient's functional status, social conditions, and living arrangements, which showed no association once other factors are considered.

"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," Gomes said.

The findings are detailed in the journal BMC Medicine.

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