513 Limited evidence for effectiveness of home-based end-of-life care

August 23, 2017

written by Brian R McAvoy.

Clinical question
Compared with inpatient hospital or hospice care, how effective is home-based end-of-life care?

Bottom line
Home-based end-of-life care increased the likelihood of dying at home compared with usual care (high-quality evidence). It was unclear whether home-based end-of-life care increased or decreased the probability of being admitted to hospital. Home-based end-of-life care might slightly improve patient satisfaction at 1-month follow-up and reduce it at 6-month follow-up (low-quality evidence). The effect on caregivers was uncertain (low-quality evidence). The intervention might slightly reduce healthcare costs (low-quality evidence). No trial reported costs to patients and caregivers.

Caveat
Trials were non-blinded, and participants crossed over between intervention and control groups. There are ethical concerns with randomising people at the end of their life rather than letting them exercise their choice of where they want to be cared for. In addition, measuring symptoms and quality of life is difficult, and may be done by a proxy (eg, a nurse, doctor or caregiver).

Context
The policy in a number of countries is to provide people with a terminal illness the choice of dying at home. This policy is supported by surveys indicating the general public and people with a terminal illness would prefer to receive end-of-life care at home.

Cochrane Systematic Review
Shepperd S et al. Hospital at home: home-based end-of-life care. Cochrane Reviews, 2016, Issue 3. Art. No.: CD009231.DOI: 10.1002/14651858. CD009231.pub2. This review contains 4 studies involving 823 participants.

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.