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. 2019 Mar 22;17(1):50.
doi: 10.1186/s12916-019-1287-8.

Specialist palliative care support is associated with improved pain relief at home during the last 3 months of life in patients with advanced disease: analysis of 5-year data from the national survey of bereaved people (VOICES)

Yousuf ElMokhallalati  1 , Natalie Woodhouse  2 , Tracey Farragher  3 , Michael I Bennett  2
Affiliations

Specialist palliative care support is associated with improved pain relief at home during the last 3 months of life in patients with advanced disease: analysis of 5-year data from the national survey of bereaved people (VOICES)

Yousuf ElMokhallalati et al. BMC Med. .

Abstract

Background: Studies have shown that more than half of patients with advanced progressive diseases approaching the end-of-life report pain and that pain relief for these patients is poorest at home compared to other care settings such as acute care facilities and hospice. Although home is the most common preferred place of death, the majority of deaths occur outside the home. Specialist palliative care is associated with improved quality of life, but systematic reviews of RCTs have failed to show a consistent association with better pain relief. The aim of this study was to examine the factors associated with good pain relief at home in the last 3 months of life for people with advanced progressive disease.

Methods: Data were obtained from the National Bereavement Survey in England, a cross-sectional post-bereavement survey of a stratified random sample of 246,763 deaths which were registered in England from 2011 to 2015. From 110,311 completed surveys (45% response rate), the analysis was based on individual-level data from 43,509 decedents who were cared for at home before death.

Results: Decedents who experienced good pain relief at home before death were significantly more likely to have received specialist palliative care (adjusted OR = 2.67; 95% CI, 2.62 to 2.72) and to have a recorded preferred place of death (adjusted OR = 1.87; 95% CI, 1.84 to 1.90) compared to those who did not. Good pain relief was more likely to be reported by a spouse or partner of the decedents compared to reports from their son or daughter (adjusted OR = 1.50, 95% CI, 1.47 to 1.53).

Conclusion: This study indicates that patients at home who are approaching the end-of-life experience substantially better pain relief if they receive specialist palliative care and their preferred place of death is recorded regardless of their disease aetiology.

Keywords: Advance care planning; End-of-life care; Home; Pain management; Palliative care; Primary care; Quality of Life.

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Conflict of interest statement

Ethics approval and consent to participate

All data analysed in this study were secondary data that had been previously anonymised. This secondary data analysis study approved by the School of Medicine Ethics Committee (SoMREC) - University of Leeds (Ref no: MREC16-046). Ethical approval for the VOICES survey was granted from Southampton University Ethics Committee and the National Statistician’s Data Ethics Advisory [36].

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow chart showing records included in this study as well as reasons for exclusion
Fig. 2
Fig. 2
Proportions of decedents with good pain relief at home by cause of death and palliative care status during last 3 months of life
See this image and copyright information in PMC

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