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Meta-Analysis
. 2016 Feb 18;2(2):CD009231.
doi: 10.1002/14651858.CD009231.pub2.

Hospital at home: home-based end-of-life care

Sasha Shepperd  1 , Daniela C Gonçalves-Bradley, Sharon E Straus, Bee Wee
Affiliations
Meta-Analysis

Hospital at home: home-based end-of-life care

Sasha Shepperd et al. Cochrane Database Syst Rev. .

Update in

  • Hospital at home: home-based end-of-life care.
    Shepperd S, Gonçalves-Bradley DC, Straus SE, Wee B. Shepperd S, et al. Cochrane Database Syst Rev. 2021 Mar 16;3(3):CD009231. doi: 10.1002/14651858.CD009231.pub3. Cochrane Database Syst Rev. 2021. PMID: 33721912 Free PMC article.

Abstract

Background: 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 that the general public and people with a terminal illness would prefer to receive end-of-life care at home. This is the fourth update of the original review.

Objectives: To determine if providing home-based end-of-life care reduces the likelihood of dying in hospital and what effect this has on patients' symptoms, quality of life, health service costs, and caregivers, compared with inpatient hospital or hospice care.

Search methods: We searched the following databases until April 2015: Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library), Ovid MEDLINE(R) (from 1950), EMBASE (from 1980), CINAHL (from 1982), and EconLit (from 1969). We checked the reference lists of potentially relevant articles identified and handsearched palliative care publications, clinical trials registries, and a database of systematic reviews for related trials (PDQ-Evidence 2015).

Selection criteria: Randomised controlled trials, interrupted time series, or controlled before and after studies evaluating the effectiveness of home-based end-of-life care with inpatient hospital or hospice care for people aged 18 years and older.

Data collection and analysis: Two review authors independently extracted data and assessed study quality. We combined the published data for dichotomous outcomes using fixed-effect Mantel-Haenszel meta-analysis. When combining outcome data was not possible, we reported the results from individual studies.

Main results: We included four trials in this review and did not identify new studies from the search in April 2015. Home-based end-of-life care increased the likelihood of dying at home compared with usual care (risk ratio (RR) 1.33, 95% confidence interval (CI) 1.14 to 1.55, P = 0.0002; Chi(2) = 1.72, df = 2, P = 0.42, I(2) = 0%; 3 trials; N = 652; high quality evidence). Admission to hospital while receiving home-based end-of-life care varied between trials, and this was reflected by a high level of statistical heterogeneity in this analysis (range RR 0.62 to RR 2.61; 4 trials; N = 823; moderate quality evidence). Home-based end-of-life care may slightly improve patient satisfaction at one-month follow-up and reduce it at six-month follow-up (2 trials; low quality evidence). The effect on caregivers is uncertain (2 trials; low quality evidence). The intervention may slightly reduce healthcare costs (2 trials, low quality evidence). No trial reported costs to patients and caregivers.

Authors' conclusions: The evidence included in this review supports the use of home-based end-of-life care programmes for increasing the number of people who will die at home, although the numbers of people admitted to hospital while receiving end-of-life care should be monitored. Future research should systematically assess the impact of home-based end-of-life care on caregivers.

PubMed Disclaimer

Conflict of interest statement

BW is a full‐time salaried employee of the National Health Service in the UK. Her responsibilities include the provision of specialist palliative care services (in the hospice, community, and hospital), service development, education, and research in palliative care. Neither she, nor her organisation, stands to gain or lose from the conclusions of this review, but like other services within the National Health Service, the conclusions of this review may inform future service development or commissioning, or both.

DCGB: none. SS: none. SES: none.

Figures

1
1
Study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Place of death, Outcome 1 Dying at home.
1.3
1.3. Analysis
Comparison 1 Place of death, Outcome 3 Dying in hospital.
1.5
1.5. Analysis
Comparison 1 Place of death, Outcome 5 Dying in a nursing home.
2.1
2.1. Analysis
Comparison 2 Unplanned admissions, Outcome 1 Admitted to hospital.
6.4
6.4. Analysis
Comparison 6 Resource use and cost, Outcome 4 Number of inpatient days.
See this image and copyright information in PMC

Update of

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