EFFECTIVENESS OF HOME-BASED END-OF-LIFE CARE: A SYSTEMATIC REVIEW AND META- ANALYSIS

Abstract

Background The rate of home deaths remains low in developed countries despite the majority preferring home death, especially amongst terminally ill patients. Place of death is closely linked to the setting of end-of-life care. Terminally ill patients have lower rates of home deaths as most receive end-of-life care in inpatient hospitals/hospices. Ineffective and inadequate home-based end-of-life care could explain this. Aims This review aims to determine if providing home-based end-of-life care increases the chances of dying at home, and its effectiveness on patient/caregiver outcomes and costs relative to usual care (inpatient hospital/hospice). Data sources Search conducted in CENTRAL, MEDLINE, Embase, CINAHL and PsycINFO in January 2021. Eligibility criteria Randomised Controlled Trials and Controlled Clinical Trials evaluating impact of home-based end-of-life care interventions compared to hospital/hospice-based interventions on terminally ill adults at the end-of-life. Data extraction, appraisal and synthesis Two reviewers independently extract data from included studies using a specifically designed data extraction form. Two reviewers independently assessed risk of bias for each included study using the Cochrane Risk of Bias tool, disagreements resolved through discussion. A “Risk of Bias” table completed for each study. Data for dichotomous outcomes summarized using risk ratio then pooled using Mantel-Haenszel method. Data displayed through forest plots in meta-analysis. No other data suitable for meta-analysis. 2 Results 6 studies fulfilled inclusion criteria (N=1415), 4 studies (N=1129) suitable for metaanalysis. Due to heterogeneity (I2=88%), subgroup analysis performed. RCTs showed significant benefit for intervention for likelihood of home death (risk ratio (RR) 1.34, P=0.0002). Other results reported narratively. Implications Evidence supports home-based end-of-life care to increase proportion of home deaths. Hospital admissions and time at home should be investigated further. Increased caregiver burden for home-based end-of-life care needs future research including evaluations of costs needed. Future care costs analyses should account for financial impact of increased caregiver burden.