MONDAY, Sept. 13 (HealthDay News) -- For people with advanced
cancer, dying at home rather than the hospital results in higher
quality-of-life scores at the end of life, and may be easier on the
patients' caregivers as well.
A study published online Sept. 13 in the
Journal of Clinical Oncology found that compared to people
who died in intensive care units (ICU) or other areas of a
hospital, when people died at home, their loved ones were less
likely to develop post-traumatic stress disorder or prolonged grief
disorder, marked by intense, disabling grief that goes on longer
than six months.
"Where someone dies has important implications for those they leave behind," said the study's lead author, Dr. Alexi Wright, an instructor in medicine at Harvard Medical School and the Dana-Farber Cancer Institute in Boston.
"It's really important for people to articulate what they want. Dying at home may improve your own quality of life before death and it may improve your loved ones' grief after your death," she noted.
While most cancer patients prefer to die at home, that's not
always what happens, according to background information in the
study. More than one-third of cancer patients die in the hospital
and 8 percent die in the intensive care unit. Almost one-quarter of
Medicare costs stem from intensive care treatment during the last
month of life, according to the study.
To get an idea of whether the location where death occurs is
associated with a better quality of life for patients at the end of
life, and whether or not the place of death affects caregivers,
Wright and her colleagues recruited 342 terminal cancer patients
and their primary caregivers.
The cancer patients were interviewed at the start of the study,
which was a median time of about 4.5 months before they died. Their
caregivers were also interviewed when the study began and then
around two weeks after the death of their loved one to discuss the
quality of life experienced by their loved one at the end of life.
In addition, the bereaved caregivers were also interviewed 6 months
The researchers found that people who died in the ICU or other
areas of the hospital had more physical and emotional distress at
the end of their lives, and had a poorer quality of life, compared
to those who died at home with hospice care.
And, those who died at home appeared to have more well-adjusted
loved ones after the death, reported the study.
"The place of death and the amount of medical treatment received shaped the bereavement experience. There was a fivefold increase in post-traumatic stress disorder in people whose loved ones died in the ICU versus at home," said Wright. "While people may think that dying at home might be more frightening for caregivers, it may ultimately help them heal."
Wright's group also found that the risk of prolonged grief
disorder among those whose loved ones died in the hospital was much
higher -- almost 22 percent compared to 5.2 percent among
caregivers whose loved ones died with home hospice.
Wright said the differences may stem from the activities that
may take place in the hospital or ICU before death, due to the
frightening nature of aggressive lifesaving care, such as
cardiopulmonary resuscitation or mechanical breathing devices.
"This study wasn't surprising. If patients and family members are in a familiar and comfortable environment, they'll likely have a better outcome in terms of quality of life," said Dr. Steven Libutti, director of the Montefiore-Einstein Center for Cancer Care in New York City. "A clearly unanswered question, though, is how do we decide when we've reached the end of our likely successful therapies? When do you come to an acceptance that you've exhausted all reasonable possibilities and transition to end-of-life care?"
Other experts stress that quality of life is an essential
"Making the quality of life better for a patient with a terminal diagnosis is often more valuable than attempting to get an extension of life at the cost of quality," said Wright.
Learn more about hospice care from the
National Hospice and Palliative Care
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