But avoiding the hospital isn’t always feasible and may not be best for all patients, says Eduardo Bruera, M.D., chair of palliative care and rehabilitation medicine at the University of Texas MD Anderson Cancer Center, in Houston. Bruera was not involved in the study.
Dying at home may be beneficial “when the patient has access to family support, or when the home environment is appropriate, or when the clinical problems are not so severe,” Bruera says. On the other hand, he adds, a hospital may be preferable if a patient lacks a good support network or is experiencing physical symptoms, such as pain or shortness of breath.
“Sometimes dying at home is more frightening for the family member, particularly if medical crises emerge that they don’t know how to deal with,” Prigerson says.
The study findings were published this week in the Archives of Internal Medicine.
Prigerson and her colleagues interviewed patients and their caregivers an average of four months before the patient died. Two to three weeks after the death, the caregivers—as well as the patients’ doctors—answered additional questions about the patient’s care, physical comfort, and psychological state in the final week of life.
Although the study makes a contribution to the growing body of literature on end-of-life care, the fact that the researchers relied on caregivers and doctors to describe the patient’s experience is a shortcoming, says Michael Levy, M.D., director of the pain and palliative care program at Fox Chase Cancer Center, in Philadelphia.
“You just don’t know how much…is the caregiver’s perception and how much of it is the real patient’s quality of life,” Levy says. “A daughter may think her mother’s quality of life is bad because she can’t move, but if the mother can teach the daughter her favorite recipe, the mother might think it’s a good day.”