PHOTO: Dr Gomes said it was encouraging pain levels were similar when dying at home to that in hospital.(By Rosie O’Beirne)
Dying in the comfort of your own home may result in a more peaceful death, with similar pain to being in hospital and less intense grief for loved ones, new research suggests.
The study from Cicely Saunders Institute at King’s College London found terminally ill cancer patients who died at home experienced similar pain levels but more peace in their last week of life compared to dying in hospital.
Relatives of more than 350 passed cancer patients took part in the study, which was published in BioMed Central. Half of those died in hospital and half at home.
Lead author Barbara Gomes said patients often feared being at home, believing they were placing a burden on their family.
“However, we found that grief was actually less intense for relatives of people who died at home,” she said.
Australians say if they had the opportunity they would prefer to die at home.
Professor Hal Swerissen, Grattan Institute
Dr Gomes said it was encouraging the research also showed pain levels were similar.
“Many people with cancer justifiably fear pain. So it is encouraging that we observed patients dying at home did not experience greater pain than those in hospitals where access to pain relieving drugs may be more plentiful,” she said.
Prior research shows home deaths have declined and hospital and residential care deaths have increased, but most people would prefer to die at home.
The study concluded that as most people wished to die at home, and that is was a better experience, “discussion of preferences, GP home visits, and relatives to be given time off work” were required to make the goal realistic.
Australians’ reluctance to discuss death, narrow conversations with health professionals and lack of community services make it hard for people to die at home, Grattan Institute’s Professor Hal Swerissen said.
“The really big stoppages that stop more people from dying at home are people don’t have the conversation,” Professor Swerissen told the ABC.
“We’re not good at saying to people, ‘it’s important that you plan for your own death’. People don’t like talking about mortality.
“Things are done in unplanned ways when it does reach the point when there isn’t much time left.”
He said without planning, situations could escalate where patients ended up in emergency and staying in hospital to die.
Professor Swerissen’s own research shows 70 per cent of Australians want to die at home, but only 14 per cent do.
People die at home twice that rate in New Zealand, the US, Ireland and France, he said.
“Australians say if they had the opportunity they would prefer to die at home,” he said.
“People say the sorts of things what they prefer as a good death is the ability to be around friends and family — provided they get good quality care — so they have the opportunity say goodbye and put their affairs in order.
“They [want to] die in circumstances where they are comfortable.”
But he said that was difficult when support from community services was lacking.
“It can be very stressful being a carer — it takes an enormous amt of effort to support someone dying,” Professor Sweissen said.
“We were very clear when we did our research what is need to make it happen — [there has to be] much bigger emphasis on providing community-based support.”
Professor Swerissen said medical staff were not always having the right conversations with patients and families.
“People don’t go through the risks of treatment enough and don’t actually ask the question, what is important to you?” he said.
He said those risks include radiation treatment, for example, which in terminal situations can extend life but sometimes also end it faster.
“Is it important to die at home with friends and family? Do you really want the extra two months of life? And what circumstances should we stop treatment and start making your comfortable?” Professor Swerissen said when listing what health professionals should ask patients.
A report from the Grattan Institute, Dying Well, released last year, showed with an investment of $237 million, Australian could double the amount of people who are supported to die at home.
About the same amount could be released from institutional care spending to pay for it, the report said.
“Thank you so much. We could not have gotten through the last week without the help from your team. They were all so supportive and were such wonderful nurses.”
“Jackie (Regal Nurse) gives you a feeling of security. She knows what she is doing, she lets you know when she is coming next time”
“The Regal Nurse would make sure I was dry – even between my toes.”
“The Occupational Therapist in the hospital defined all the in home care we had to have – one of the Nurses recommended Regal and said they provided 7 day care. I got in touch and we went from there”
“If I lost him (the Regal Nurse) I’d feel bereft. It’s almost like when you are a soldier, you have that mentality of a band of brothers”
“Herb (Regal Nurse) is very caring.”
“I could not fault the service. All the nurses were pleasant and very efficient. All the staff were very obliging and attentive”
“I found the nurses to be very helpful and caring”
“I am very happy with the treatment I have received from the Regal Community Nurses”
“In the environment in which you are delivering services to the community, the ideas of others I thought were enlightening and I felt that you showed a keen awareness to listen and learn.”
“Your staff were efficient, courteous and knowledgeable. This was a great service enabling me a limited stay in hospital. Grateful to use your service twice this year – I am so glad I only have two knees! Thank You”
“As the grand-daughter of a soldier who served In both World Wars I and II, I feel privileged to lead a home health service that cares for so many whose lives have been impacted by war”
“At all times Regal Health Services has displayed excellent interaction with the patients. We always find the staff display the highest professional integrity”
“Regal believes in quality and is prepared to be publicly scrutinized to attest to this quality in process and performance”
“I am a 91-year-old ex-serviceman and have been receiving help from Regal Health Services for some considerable time and I can’t speak highly enough of the health benefits I have received from them. My Nurse has helped me recover from numerous accidental falls on discharge from a hospital. Her happy disposition and general demeanor has a psychological healing effect in itself”
“I had three uncles who served in World War II who shared with me their many experiences of war and wisdom passed down through generations. I am grateful for the many sacrifices our war veterans have made that allow us our freedom today”
“Regal have been market leaders for 2 generations in promoting consumer empowerment and registered nurse led professional care in community health. Their commitment to measurable quality outcomes and sheared decision making promoting innovative models of care is outstanding. I can only wish them success as the real winners are the recipients of care in their homes.”
“We are forever grateful to Nicholas for locating our mother who would not have survived for many more hours in her situation. Nicholas called the ambulance and stayed with our mother until help arrived. Nicholas also stayed onsite to provide information and answer questions from the emergency personnel (Medical, Police, & Fire Department) & information to her family.”