Home palliative care works: but how?

Sarmento, V.P. et al. BMJ Supportive & Palliative Care. Published Online: 23 February 2017


Objective: To understand patients and family caregivers’ experiences with home palliative care services, in order to identify, explore and integrate the key components of care that shape the experiences of service users.

Conclusions: Home palliative care teams improve patients and caregivers experience of security when facing life-limiting illnesses at home, by providing competent care and being present. These teams should therefore be widely available and empowered with the resources to be present and provide competent care.

Read the full article here

Dying at home of cancer: whose needs are being met?

Pottle, J. et al. BMJ Supportive & Palliative Care. Published online: 16 January

clasped-hands-541849_960_720Objectives: Supporting patients to die in the place of their choosing is an important aspect of end of life care. Our study set out to answer the question: ‘How does the home environment influence perceptions of quality of death, and the experience of caring for the dying at home, for family carers and healthcare professionals (HCPs)?

Conclusions: We have shed light on the complexity of balancing the demands and the satisfaction of caring for someone dying at home. The ability to manage these conflicting needs influenced whether carers perceived the home setting as the best place for the person to have received care in their last days of life.

Read the full abstract here

Helping people to be cared for and die at home

This Housing LIN Practice Briefing looks at the importance of end of life care delivered at home, describing the context, inequalities in end of life care, examples of good or emerging practice, and recommendations for actions. Funded by Public Health England, it is intended to be a practical guide for those working in mainstream and/or specialist housing, care and support and public health to understand their respective roles, and how they may work together, to help people to have their end of life care wishes met.

Full briefing: End of Life Care: Helping people to be cared for and die at home

Dying at home more peaceful, but requires discussion

For terminally ill cancer patients and their loved ones, dying at home can be more peaceful with less grief among family members. But the option requires talking about preferences, access to a comprehensive home care package, and time off from work for family caregivers, according to a study in BMC Medicine. Barbara Gomes, BSc, MSc, PhD, of the Cicely Saunders Institute at King’s College London, and colleagues questioned 352 bereaved family members of patients who died in the hospital or at home. Wherever they passed away, patients experienced about the same amount of pain.

Full reference:  Is dying in hospital better than home in incurable cancer and what factors influence this? A population-based study.  BMC Medicine 2015, 13:235.

Doctors’ and nurses’ views and experience of transferring patients from critical care home to die: A qualitative exploratory study

Coombs, M. et al. Doctors’ and nurses’ views and experience of transferring patients from critical care home to die. Palliative Medicine Online – 17 December 2014

The practice of transferring critically ill patients home to die is a rare event in the U.K., despite the positive view of health care professionals. Challenges to service provision include patient care needs, uncertain time to death, and the view that transfer to community services is a complex, highly time-dependent undertaking.

While there is evidence of this choice being honoured and delivered for some of the critical care population, it remains debatable whether this will become a conventional practice in end of life in this setting.

“You only have one chance to get it right”: A qualitative study of relatives’ experiences of caring at home for a family member with terminal cancer

Totman, J. et al. ‘You only have one chance to get it right’. Palliative Medicine Online – 29 January 2015

Participants’ experiences of being a caregiver and of professional support were highly varied. The analysis generated 15 themes which were organised into a framework based on Yalom’s four “existential conditions”: responsibility (e.g., “being the linchpin of care,” “you only have one chance to get it right”), isolation (e.g., “being on my own,” “being held in mind”), death (e.g., “knowing but not knowing”) and meaningfulness (e.g., “giving something back,” “acceptance and gratitude”). Healthcare professionals were perceived as influential in both helping and hindering relatives in meeting the challenges they faced.