Specialist nursing care enables more people at end of life to die at home and reduces hospital treatment, study finds

BMJ 2012; 345 doi: (Published 13 November 2012) Cite this as: BMJ 2012;345:e7679
  1. Zosia Kmietowicz
  1. 1London

People at the end of the life who receive specialist nursing care at home are more than twice as likely to die at home rather than hospital and three times less likely to need hospital care as those who get standard care, a study of nearly 60 000 patients has found.1

The study, which was conducted by the Nuffield Trust on behalf of Marie Curie Cancer Care, looked at the experiences of 29 538 people at the end of life who received specialist care from the Marie Curie nursing service and the same number of matched controls, who may have received other nursing care.

It found that 77% of people who received Marie Curie nursing care and 35% of those who did not receive the service died at home. Eight per cent of the patients who received specialist care and 42% of the control group died in hospital.

Currently over half of all deaths occur in hospitals and only around a fifth at people’s homes, despite surveys showing that most people would prefer to die at home.

The effect of the specialist nursing was even greater in the quarter of patients who did not have a history of cancer. In this group 81% of the people who received specialist care and 29% of controls died at home.

The researchers also looked at the use of hospital care among the two groups of patients at the end of life. They found that 12% of Marie Curie patients and 35% of the control group had an emergency admission and an additional 8% and 29%, respectively, attended an emergency department but were not admitted.

Overall, people who received Marie Curie specialist nursing care incurred £1140 (€1425; $1810) less in hospital costs than patients in the control group from the first contact with the service until death.

Lower costs of emergency hospital admission accounted for 75% of this difference. However, the report said that these cost savings would need to be offset against other costs, including the nursing care itself and possible increased use of other services, for an evaluation to be made of the “whole system” effect on the cost of care.

Martin Bardsley, the Nuffield Trust’s head of research and a member of the evaluation team, said, “In an increasingly tight financial climate for public services, we need to identify models of patient care that maintain or improve the quality and experience of care patients receive without large additional costs.

“The results of this evaluation offer clear evidence of the beneficial impacts of a commonly used package of home based nursing care for people at the end of their lives. The research provides strong support for increased investment in this area, and commissioners should consider these findings.”

Jane Collins, chief executive of Marie Curie Cancer Care, said, “Our priority is to work with commissioners to ensure they understand the end of life need and provision in their area and redesign services to better support patients and families. It is only by ensuring that we get more people out of hospital and into more appropriate care that the government will be able to meet the twin challenges of an ageing society and ongoing economic pressures.”


Cite this as: BMJ 2012;345:e7679