Illnesses like COPD, multiple sclerosis, HIV, heart disease, or cancer can require advanced care during treatment and in late stages of the diseases. Many people prefer to be at home during these times instead of in medical care facility but the advanced care that is required can make this difficult. It can also place a great deal of stress on family caregivers. Home Palliative care is treatment at home that focuses solely on relieving pain and other symptoms, making it possible to stay home.
Most research on palliative care is focused on people with cancer. Researchers from the Cochrane Database wanted to see if home-based palliative care can help those with a variety of severe illnesses to successfully stay home. The review, published in the Cochrane Library, found that home palliative in patients with severe or advanced diseases was associated with reduced burden and increased likelihood of dying at home instead of in a medical facility.
The systematic review included 23 randomized or controlled trials with a total of 37,561 adults with advanced illness and 4,042 family caregivers. Patients received home-palliative care or usual care which may have included care in long term medical facility, hospital care, or hospice care. Researchers collected information about patients symptom control, quality of life, and stress on family caregivers as well as whether the patients died at home or in a medical facility.
Patients that received home-palliative care were more than twice as likely to be able to die at home than those who had usual care. In addition, home-palliative care was associated with better symptom control in 3 trials with 2,107 patients. There was no increase in family caregiver burden with home-palliative care compared to usual care.
Systematic reviews pool several smaller, similar trials. This large pool increases the probability that the outcomes are true, however, the review is only as reliable as the studies that are included. In this case, the trials included in the systematic review were randomized trials which are considered very reliable.
Not all who wanted to remain at home were able to do so. There are many factors to consider with the care of advanced illnesses including management of symptoms to keep the person as comfortable as possible, decreasing burden of family caregiver, and managing financial burdens. Talk to your doctor and care team to find what options are best for your situation and what resources may be available. Also talk to your medical team and family about your wishes for advanced and end of life care, like dying at home. This will help them make decisions in case you can not communicate yourself when the time comes.
Get Palliative Care
Gomes B, Calanzani N, Curiale V, et al. Effectiveness and cost-effectiveness of Home Palliative Care Services for Adults with Advanced Illness and Their Caregivers. Cochrane Database of Systematic Reviews 2013, Issue 6.
Last reviewed August 2013 by Michael Woods, MD