Dying at Home

iStock_000056500374_MediumWhen people choose to leave the hospital near the end of life, do they die more quickly than those who elect to stay?  Rick and I discuss this study on PodMed this week, as published in Cancer, and were both informed and pleased to learn that those who go home live longer in the short term, over days and weeks, than those who remain hospitalized, while those with a life expectancy of a few months live about the same length of time.  Our hope is that this study will relieve the burden of guilt experienced by some family members and loved ones that someone isn't receiving the very best care and may die more quickly at home.

Just over 2000 patients were enrolled in this study, conducted at 58 palliative care practices in Japan. Here's the data: A total of 1607 patients actually died in a hospital, and 462 patients died at home. The survival of patients who died at home was significantly longer than the survival of patients who died in a hospital in the days’ prognosis group (estimated median survival time, 13 days [95% confidence interval (CI), 10.3-15.7 days] vs 9 days [95% CI, 8.0-10.0 days]; P5.006) and in the
weeks’ prognosis group (36 days [95% CI, 29.9-42.1 days] vs 29 days [95% CI, 26.5-31.5 days]; P5.007) as defined by Prognosis in Palliative Care Study predictor model A. No significant difference was identified in the months’ prognosis group. Since most people identify their preference as dying at home, this study should support both patients and their loved ones in making such a decision.

Other topics this week include cardiac interventions following cardiac assessment prior to surgery in JAMA Internal Medicine, and two from NEJM: HRT timing and Lyme disease and long term antibiotic use.  Until next week, y'all live well.

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