Home and hospice deaths increasing since the launch of national programme
In England, hospital is still the most common place for patients with cancer to die but an increase in home and hospice deaths since 2005 suggests that the National End of Life Care Programme (a Programme to promote the rollout of national end-of-life care initiatives) has helped more people to die at their preferred place of death, according to a study at the Cicely Saunders Institute funded by the National Institute for Health Research Health Services and Delivery Research (NIHR HS&DR) Programme, published in this week’s PLOS Medicine.
In a large analysis led by Dr Wei Gao and Professor Irene Higginson of the Cicely Saunders Institute, King's College London, the authors used death registration data collected by the Office of National Statistics to identify all 2.28 million adult cancer deaths in England between 1993 and 2010.
Throughout the study period hospital was the commonest place of death—48% of cancer deaths—whereas 24.5% deaths of cancer patients occurred at home and 16.4% occurred in hospices.
The proportion of home deaths increased after 2005 whereas the proportion of hospital deaths declined. The proportion of deaths in hospices also increased over the study period. The National End of Life Care Programme in England was launched in November 2004.
Being single, widowed or divorced was linked with a higher chance of dying in hospital than being married. Being aged over 75 years was also linked to a higher chance of dying in hospital than in younger age groups although older people were more likely to die at home or in a hospice after 2006 than in earlier periods. Cancer type also played an important role in place of death: for example, patients who died from blood cancer and lung cancer were more likely to die in hospital than patients with colorectal cancer throughout the study period.
Professor Irene Higginson, Director of the Institute said: “This large-scale, population-based study found that hospitals remain the most common place of death for patients with cancer. Following a prolonged period of plateau, there was a steady downward trend in hospital deaths (about 50%) from 2005 onwards. The pattern was mirrored by increasing home deaths. This trend coincides with the launch of the National End of Life Care Programme in November 2004 in England, which was based on research evidence about patient preferences and possible solutions."
Dr Wei Gao said: "This internationally important study, supported by NIHR, shows a likely positive effect of the National End of Life Strategy on enabling more patients with advanced cancer to die at home if they wish. There is a sustained reversal of earlier trends, coinciding with the implementation of the National Strategy. However, there are still many patients with advanced cancer who die in hospital, which is their least preferred place. We have identified new at risk groups, especially people who are single, widowed or divorced, along with known groups such as haematological cancer, lung cancer, older age and deprivation, that should be a focus for end-of-life care improvement and future strategy."
Dr Wei Gao said the study concludes: “More efforts are needed to reduce hospital deaths. Healthcare facilities should be improved and enhanced to support the increased home and hospice deaths .... People who are single, widowed or divorced should be a focus for end-of-life care improvement, along with known at risk groups such as haematological cancer, lung cancer, older age and deprivation.”
The paper is freely available here
1. The National Institute of Health Research Health Services and Delivery Research (NIHR HS&DR) Programme was established to fund a broad range of research. It builds on the strengths and contributions of two NIHR research programmes: the Health Services Research (HSR) programme and the Service Delivery and Organisation (SDO) programme, which merged in January 2012. The programme aims to produce rigorous and relevant evidence on the quality, access and organisation of health services, including costs and outcomes. The programme will enhance the strategic focus on research that matters to the NHS. The HS&DR Programme is funded by the NIHR with specific contributions from the CSO in Scotland, NISCHR in Wales and the HSC R&D Division, Public Health Agency in Northern Ireland.www.netscc.ac.uk/hsdr/
2. The National Institute for Health Research (NIHR) is funded by the Department of Health to improve the health and wealth of the nation through research. Since its establishment in April 2006, the NIHR has transformed research in the NHS. It has increased the volume of applied health research for the benefit of patients and the public, driven faster translation of basic science discoveries into tangible benefits for patients and the economy, and developed and supported the people who conduct and contribute to applied health research. The NIHR plays a key role in the Government’s strategy for economic growth, attracting investment by the life-sciences industries through its world-class infrastructure for health research. Together, the NIHR people, programmes, centres of excellence and systems represent the most integrated health research system in the world. For further information, visit the NIHR website (www.nihr.ac.uk).This article presents independent research funded by the National Institute for Health Research (NIHR). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.
The Cicely Saunders Institute of Palliative Care:
Dame Cicely Saunders, founder trustee of Cicely Saunders International, worked actively for the creation of a centre of excellence housing research, education including palliative care courses, information provision and clinical care.
The mission of the Institute established in her name is to pioneer the very best in palliative care and rehabilitation by integrating:
- Cutting-edge research - committed to building new knowledge and discovering new treatments through world-leading ethical and robust clinical, applied and health services research
- Skilled multi-professional care - delivering top-quality evidence-based clinical care and support to patients and carers, for life and living, and death and dying
- Innovation in engagement and education - to embed change in policy and practice nationally and internationally, engage with patients and public, and inspire tomorrow's leaders in the field from around the world.
This seeks to enable ethical and robust research to quickly feed into care and practice, improving palliative care and enabling people to live better, with dignity and the least possible suffering.