Is dying at home linked to more peace for cancer patients and less grief for their relatives?

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Studies show that most patients with advanced cancer prefer to die at home, but not everyone has an equal chance to do so, and evidence is unclear about whether dying at home is better. This study aimed to examine associations between place of death, health services used, pain, feeling at peace, and grief intensity.

The researchers conducted a mortality follow-back study of 352 cancer patients who died in London, UK: 177 in hospital and 175 at home. Bereaved relatives identified through death registrations completed a questionnaire with validated measures of the patient's pain and peace in the last week of life and their own grief intensity. The researchers examined factors influencing death at home and associations between place of death and pain, peace, and grief.

For most patients (80%), the place of death was where they had lived during their last week of life. Four factors explained more than 91% of home deaths: the patient's preference, the relative's preference, home palliative care, or district/community nursing. Death at home was also more likely when the relative knew the illness was incurable and the patient discussed preferences with family. Death in hospital was associated with more hospital days, fewer general practitioner (GP) home visits, and fewer days taken off work by relatives.

After adjustment for confounders, patients who died at home had similar pain levels but more peace in their last week of life than those who died in hospital (ordered log odds ratio 0.69, P = 0.007). Their relatives' grief was less intense than that of relatives of patients who died in hospital (β = -0.15 around the time of death and -0.14 at questionnaire completion, P = 0.02).

The researchers concluded that dying at home may be better than dying in hospital for peace and grief, but requires discussion of preferences, GP home visits, and time off work for relatives. The study was registered in the National Institute of Health Research (NIHR) Clinical Research Network Portfolio, UKCRN7041.