LOS ANGELES — Cancer patients who die at home with hospice services had a better quality of life in their final days compared with similar patients who died in the hospital or intensive-care unit, according to a new study.
Moreover, the family members of the patients fared worse psychologically if their loved ones died in a hospital or ICU rather than at home.
The study, published Tuesday in the Journal of Clinical Oncology, suggests that experiences at the end of life are shaped by the setting. Hospital and ICU care may emphasize staying alive at all costs, while hospice care emphasizes managing symptoms and comfort at the end of life.
The study is also the first to show that caregivers of cancer patients who die in an ICU are at heightened risk for post-traumatic stress disorder.
The study, from researchers at the Dana-Farber Cancer Institute in Boston, followed 342 people with advanced cancer and their family caregivers for an average of four months.
The patients’ quality of life was assessed by their caregivers within two weeks of death. The caregivers answered questions about their own psychological distress at the time of death and six months later.
On a scale of zero to 10 — with zero being the worst — patients who died in the hospital were rated on quality of life at 5.3 compared with 5.0 in the ICU, 6.6 at home with hospice and 7.3 at home without hospice. Patients receiving hospice at home were rated highest on physical comfort, at 6.6, compared with 3.6 in the ICU.
The authors noted the reason for the discrepancy may be due to the types of patients who choose to die at home with hospice care. But, they said, it’s more likely the rating differences have to do with the different goals of an ICU and hospice.
Among caregivers, 21 percent of those whose loved ones died in the ICU or hospital developed post-traumatic stress disorder six months later, compared with 4.4 percent of those whose loved ones died at home with hospice.
