People dying of a terminal cancer could experience a few more days of life if they opt to spend their last days at home instead of in a hospital, according to international evidence. Japanese researchers have investigated whether there’s a difference between home and hospital-based palliative care in prolonging life, following a cultural assumption that a terminally-ill patient would rapidly decline if they received care outside a hospital.
They conducted a large study, involving 2,000 terminal cancer patients, a quarter of which opted to die in the comfort of their own home while receiving palliative care services.
The paper’s authors found that, all things being equal, this home-based group lived an average of four days longer than patients who chose to die in a hospital.
“Our finding—that home death does not actually have a negative influence on the survival of cancer patients at all, and rather may have a positive influence—could suggest that the patient and family can choose the place of death in terms of their preference and values,” says lead author, Dr Jun Hamano of the University of Tsukuba in Japan.
“Patients, families, and clinicians should be reassured that good home hospice care does not shorten patient life, and even may achieve longer survival.”
Patients, families, and clinicians should be reassured that good home hospice care does not shorten patient life, and even may achieve longer survival.
The study, published in the online journal CANCER this week, involved 58 specialist palliative care services throughout Japan.
The patients who chose to stay at home to die survived an estimated 13 days versus those who received care in a hospital at the end of their life and survived nine days. The average age of patients was between 69-to-70 years old.
Palliative Care Australia CEO, Liz Callaghan, welcomes the study’s findings but believes that, unlike the Japanese, most Australians know that they could have a good death at home.
“A person’s length of life is also of great importance in Japan,” says Ms Callaghan. “You might have a longer life but it is not of great quality. Australians also place a greater focus on quality of life.”
“Palliative care is about living life to the full, having a quality of life for as long a period as you can. That’s what’s important.”
She adds that providing a terminally ill cancer patient with a quality death is something Australia does well.
According to the global 2015 Quality of Death Index, Australia is one of the best places to die, ranking second in the world for providing the terminally ill with a high quality of death.
However, Ms Callaghan says, we could do better. A well-resourced health system that supports carers to look after the terminally ill could improve a patient’s quality of death if they choose to die at home.
The dying must also be able to access multidisciplinary care, no matter where they live, and have their pain and symptoms managed.
Ms Callaghan explains that the terminally ill Australians should also be able to ‘choose’ where they want to die rather than being forced to spend their last days in one set location – hospital or home – because of a belief that one is better than the other.
Around 60-70 per cent of Australians say they want to die in their home, rather than in a hospital.
Studies show that around 60-70 per cent of Australians say they want to die in their own home, rather than in a hospital. However, only around 14 per cent of all Australians achieve that.
“It all really it depends on what you want at the end of your life. It’s all about having a choice.
“There are some people who want the bells and whistles at the end of their life and others don’t want any of that.
“I might want to die where I can see the sea, have my dogs next to me and be really happy, listening to classical music. And another person might want to die in a hospital with doctors looking after them.”
The key to a quality death, she says, is advance planning.
“We need very clear directions from the person who is dying about what they want so we understand what to do. Is it music or family members they want around at the end of their life?
“But if you talk about what you want at the end of life, you are more likely to receive what you want. So having conversations about death and dying is important because it means you can advocate for what you want.
“And if you understand that dying at home is a possibility, then with support, it will be something you can do.”