Patients in Home Hospice Live Longer

Most patients express a desire to die at home rather than in the hospital, if they are to die.¹ In fact, dying at home is associated with higher care satisfaction.² However, this desire may sometimes be undermined by patient concerns that leaving the hospital would jeopardize the quality of care or that electing hospice would be the equivalent of giving up. Addressing this issue, the American Cancer Society’s peer review journal, Cancer, published a study that adds to the body of evidence showing that going home with hospice improves survival and satisfaction.³

The goal of hospice is neither to shorten nor to prolong life. Hospice works to maximize quality of life through symptom control, emotional support, and resource coordination. On the other hand, when the prognosis is six months or less, a concordant body of scientific literature demonstrates that hospice services and palliative care tend to increase survival compared to the alternatives. Most recently, Jun Hamano, MD and colleagues prospectively followed 2,069 cancer patients with prognoses measured in days, weeks, or months. They compared patients receiving palliative care in hospitals to patients receiving home hospice. Among patients whose prognosis was a few days, home hospice correlated with a 44% longer survival. Among patients whose prognosis was measured in months, home hospice correlated with a 24% longer survival. The differences were statistically significant. While hospital care provides the highest level of intensive medical intervention, this data suggests that the peacefulness of home may offer benefits to patients with a prognosis measured in months or weeks. The authors state that these results should provide encouragement to patients near death who want to receive medical attention at home but have questions about the quality of care one could receive at home.

This study adds to a long-standing body of research demonstrating how patients who elect hospice tend to have longer survival, improved symptom control, greater quality of life, and greater satisfaction.^3-11 Hospice’s increased survival effect also applies when compared to patients who continue to seek curative treatments (when the prognosis is six months or less).^2,5,6 Additionally, there also appears to be a dose-response relationship, where patients referred to hospice late realize a smaller benefit compared to patients referred to hospice earlier. Hospice is designed for up to six months of service.

For families in the Greater Houston Metro and The Woodlands, Avatar Home Health and Hospice provides the kind of support this research highlights: skilled hospice care delivered where many patients most want to be, at home. With medical, emotional, and spiritual support, Avatar helps patients and families focus on comfort, dignity, time together, and quality of life when life matters most. If someone you love has a serious illness and you are wondering whether hospice care at home is the right next step, Avatar’s compassionate team can help you understand your options and respond quickly to your family’s needs.

References

1. Benson WF and Aldrich N. Advance Care Planning: Ensuring Your Wishes Are Known and Honored If You Are Unable to Speak for Yourself, Critical Issue Brief, Centers for Disease Control and Prevention. 2012. www.cdc.gov/aging.
2. Regier NG, Cotter VT, Hansen BR, Taylor JL, Wright RJ. Place of Death for Persons With and Without Cognitive Impairment in the United States. Journal of the American Geriatrics Society. 2021 Apr;69(4):924-31.
3. Hamano J, Yamaguchi T, Maeda I, et al. Multicenter cohort study on the survival time of cancer patients dying at home or in a hospital: Does place matter? Cancer. 2016 May; 122 (9): 1453-60.
4. Huo J, Lairson D, Du X, et al. Survival and cost-effectiveness of hospice care for metastatic melanoma patients. The American Journal of Managed Care. 2014; 20 (5): 366-373.
5. Saito A, Landrum M, Neville B, et al. Hospice care and survival among elderly patients with lung cancer. J Palliat Med. 2011; 14 (8): 929-939.
6. Keyser E, Reed B, Lowery W, et al. Hospice enrollment for terminally ill patients with gynecologic malignancies: impact on outcomes and interventions. Gynecol Oncol. 2010: 118 (3): 274-7.
7. Connor S, Pyenson B, Fitch K, et al. Comparing hospice and nonhospice patient survival among patients who die within a three-year window. J Pain Symptom Manage. 2007 Mar; 33(3): 238-46.
8. Christakis N, Iwashyna T, Zhang J. Care after the onset of serious illness: a novel claims-based dataset exploiting substantial cross-set linkages to study end-of-life care. J Palliat Med. 2002; 5: 515-529.
9. Christakis N. Predicting patient survival before and after hospice enrollment. Hosp J. 1998; 13: 71-87.
10. Connor S. Hospice: Practice, pitfalls, and promise. Philadelphia, PA: Taylor and Francis, 1998. 118-119.
11. Forster L, Lynn J. The use of physiologic measures and demographic variables to predict longevity among inpatient hospice applicants. Am J Hosp Care. 1989; 6: 31-34.