Patients with advanced, almost certainly terminal illnesses face a wider range of choices about their end-of-life care, including hospice and even care at home. While the majority people say they would prefer to die at home, less than a third do so, often because of aggressive care that is not consistent with the patient’s wishes. A Cochrane review summarized in JAMA looks at multiple studies on the benefits and costs of palliative care in the home for these patients with advanced illness, compared to usual care. (JAMA Summary) The reviewers found 23 relevant studies from the period 1975-2007 (note that apparently an updated review is under way, this is a bit dated) most regarding cancer patients. Receiving palliative care at home was associated with a two-fold greater likelihood of dying at home. Patients also displayed or reported fewer symptoms, but evidence for other aspects of quality of life was inconclusive. Caregivers did not report experiencing less grief for patients who received home palliative care as opposed to usual care. While some studies suggested such care was cost-effective, meaning it cost less to provide than it saved in other medical spending, overall the authors concluded there was insufficient evidence to make a judgment about cost benefits. The most important thing, by far, is that patients have their wishes respected about where to die and if palliative home care aids in that goal, that should be sufficient to encourage its use. The updated review almost certainly will reflect even greater progress toward that objective.
