The choice to die at home, rather than in a hospital, provides great comfort to both the patient and their loved ones, a new British study says.
People who die at home experience more peace in their final days and hours than they would in a hospital, with no greater pain, according to findings published Oct. 8 in the journal BMC Medicine.
Further, their relatives experience less grief in the months following their passing, said lead author Barbara Gomes, a research fellow at King’s College London.
“Dying at home happened more peacefully, and in no greater pain, than in the hospital,” Gomes said. “This could bring some comfort and help people deal with what is a very difficult time for someone who has recently lost a friend or relative to cancer.”
But the researchers also identified a set of factors that must be in place for a person to be able to die at home.
Both the patient and their relatives must be on board with the decision, the study showed. The patient also needs to have access to palliative care and nursing support in the home during their last three months of life.
These factors “are almost essential,” Gomes said. “They were present in more than 91 percent of home deaths.”
The new study involved 352 bereaved relatives of London cancer patients, 177 of whom died in a hospital and 175 who died at home. The relatives filled out questionnaires that measured the patient’s pain and peace in the last week of life, and the relative’s own intensity of grief.
The researchers found that about 25 percent of patients who died in a hospital experienced little to no peace in the last week of their lives. By comparison, only 12 percent of patients dying at home were unable to find any peace.
Being at home during one’s final days can help a person take solace in the life they lived, said Don Schumacher, president and CEO of the National Hospice and Palliative Care Organization, based in Alexandria, Va.
“The smells, the familiarity, the comfort, the love, the things they’ve helped to create, the garden they’ve built — all of this is around them,” Schumacher said. “It creates such a sense of accomplishment and nurturing and caring.”
The study also found that relatives reported that people who died at home experienced no more pain than those who died receiving hospital care.
“Many people with cancer justifiably fear pain,” Gomes said. “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.”
Dying at home also appeared to help the people left behind. Relatives reported less intense grief when the patient died at home, even months following their death.
Bereaved relatives might receive some comfort from the fact that the patient died more peacefully, Gomes said. They also may have been able to spend more time with the person in a familiar setting, helping them achieve a sense of closure.
However, dying at home requires that the patient clearly express the desire to do so, and often requires relatives to support that decision, the study found.
That means people need to have end-of-life discussions sooner rather than later with loved ones, and make their wishes clear, Schumacher said.
“Don’t wait too long to have these conversations,” he said. “There’s nothing worse than waiting until you’re in crisis, because then it’s so easy to misinterpret things.”
People also were more likely to die at home if their relatives had accepted the fact that their condition was terminal, the researchers found.
Health care professionals who are skilled in end-of-life care can help facilitate these discussions, Gomes said. They also can make sure that the topic is revisited regularly, as a person might change his or her mind or the medical situation might require that the plan be altered.
The patient also needs strong hospice support to die at home, according to the findings, and that means people living in some areas will be more apt to have their wishes obeyed.
People in the United Kingdom, the United States and Canada appear to have sufficient access to hospice care to allow them the option of dying at home, the researchers said in background information, while people in Japan, Germany, Greece and Portugal often die in a hospital because there’s less support for hospice.
“The reality may be different in other regions, particularly in those where access to home palliative care teams — specialists in controlling pain and any other challenging symptoms in the community setting — is patchy,” Gomes said.
For more on hospice care, visit the U.S. National Institutes of Health.