How do cancer patients receiving palliative care at home die? A descriptive study

Context: Data regarding the circumstances of the process of death of terminally ill patients followed at home are lacking. Objectives: The aim of this study was to describe the characteristics and assess the circumstances of the process of death of terminally ill patients followed at home. Methods: This was a prospective survey to assess the dying process of advanced cancer patients followed at home. Within a week after death, the principal caregiver was interviewed. Information from the palliative home care team and the caregiver about expectation of death, time of death, professional and nonprofessional people present at time of death, emergency admission to hospital, and administration of drugs to resuscitate was gathered. The principal clinical issues in the last two hours also were recorded. Results: In total, 181 of 222 caregivers provided information. Most deaths were expected. Palliative home care team physicians and nurses visited the patient on the day of death but were occasionally present at the moment of death. More than three people were generally present at time of death. More than two-thirds of patients died peacefully, without apparent suffering, and 35.7% of them received palliative sedation before dying. In the last two hours, the most frequent clinical issues were ranked as death rattle, dyspnea, and agitation. In 10 cases, emergency drugs for resuscitation were administered. Conclusion: This study has shown how advanced cancer patients die at home and that palliative home care may be helpful in allowing a death at home, particularly when relatives are actively involved. © 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.