What's Needed for Terminally Ill Patients to Die at Home?
Terminally Ill Patients
Family support and better home-based care are two of the key priorities needed to enable terminally ill cancer patients to die at home, say researchers in this week's BMJ.
The study, by a team at King's College London, follows the recent announcement by the UK government to shift the emphasis of care from acute hospitals to primary care.
Well over half of people with a progressive illness want to die at home and several countries, including the UK, are making substantial reforms to enhance home care. But despite these efforts, most people in the UK, the US, Germany, Switzerland, and France die in hospitals. In the UK, the proportion of home deaths for patients with cancer is falling, from 27% in 1994 to 22% in 2003.
To determine what factors influence where patients with cancer die, the researchers analysed 58 studies involving over 1.5 million patients from 13 countries.
The most important factors linked to dying at home were patients' limited function and mobility, patients' preferences, availability and level of home care, presence of live-in relatives, and extended family support.
Future policies to enable people to die at home should focus on empowering families, public education, and improving home care, say the authors. Risk assessment and training doctors in end of life care are also important priorities.
In the last three years the UK has invested