Home-based end of life care

A number of countries have invested in health services to provide care at home to patients with a terminal illness who wish to die at home. This investment is backed by surveys of the preferences of the general public and patients with a terminal illness, which indicate that most people would prefer to receive end of life care at home. We systematically reviewed the literature to see if the provision of end of life home care reduces the likelihood of dying in hospital and what effect this has on patients' symptoms, quality of life, health service costs and care givers compared with inpatient hospital or hospice care. We included four trials in our review and report that the provision of end of life home care does increase the probability of dying at home. However, it is not clear if this also results in more people being transferred to hospital during this phase of their illness. There are few data on the impact these services have on family members and lay care givers.