Most people prefer to die at home, if they are to die. Compared to dying in a facility, people often feel that home is better at offering comfort, companionship, and peace. On the other hand, hospitals provide the best lifesaving, high-tech care. People sometimes fear that leaving the hospital would lower the quality of care or that enrolling in hospice would be giving up. Fortunately, the desire to have both the comforts of home and high-quality care do not have to be in conflict. In fact, a major study published in Cancer, the peer-reviewed medical journal of the American Cancer Society, finds that people in home hospice have longer survival than people with similar conditions receiving palliative care in hospitals.1
Does Hospice Strive to Lengthen Life?
The goal of hospice is not to affect length of life. Hospice focuses on quality of life during a very important time. However, when a person’s life expectancy is six months or less, a consistent body of scientific research shows that people live longer in hospice compared to other healthcare alternatives.2-9 When people qualify for hospice, many of them are at a point where focusing on comfort restores energy and improves the patient condition.
Home Hospice Versus Hospital Palliative Care
In the study published in Cancer, Jun Hamano MD, and colleagues identified 2,069 cancer patients whose life expectancy was measured in days, weeks, or months. Across 58 specialist palliative care services, they compared patients receiving palliative care in hospitals to patients receiving home hospice. Among patients whose life expectancy was a few days, hospice correlated with 44% longer survival. When the life expectancy was measured in months, home hospice was associated with a 24% longer life. Hospital care provides the highest level of intensive medical intervention, but the peacefulness of home offers important advantages to people who qualify for hospice. Hospice’s increased survival effect even applies when the comparison group is seeking curative treatments.2,5,6
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- Christakis N. Predicting patient survival before and after hospice enrollment. Hosp J. 1998; 13: 71-87.
- Connor S. Hospice: Practice, pitfalls, and promise. Philadelphia, PA: Taylor and Francis, 1998. 118-119.
- 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.