For caregiver, death at home is less trauma

ICU deaths carry risk for grief disorder

Cancer patients who die in the hospital or an intensive care unit (ICU) have worse quality of life at the end-of-life, compared to patients who die at home with hospice services, and their caregivers are at higher risk for developing psychiatric illnesses during bereavement, according to a study by researchers at Dana-Farber Cancer Institute in Boston.1

One striking finding of the study was that bereaved caregivers of patients who died in an ICU were five times more likely to be diagnosed with post-traumatic stress disorder (PTSD) compared with caregivers of patients who died at home with hospice services.

In addition, families and loved ones of patients who died in the hospital, though not in an ICU, were at higher risk of developing prolonged grief disorder (PGD), an intense and disabling form of grief that lasts more than six months.

The authors noted that most cancer patients would prefer to spend their last days at home. However, they said, 36% die in a hospital and 8% die in an ICU, and they might be subjected to invasive and painful procedures at the end of life.

The report contains findings from a prospective, longitudinal study of advanced cancer patients recruited at seven cancer centers from 2002 to 2008. Patients and caregivers — primarily family members — were interviewed at the beginning of the study. Their medical charts were reviewed at that point and after the patients died, on average 4.5 months later. Within two weeks of the death, researchers interviewed the caregiver most closely involved with the patient's care during the last week of life. They interviewed the caregiver again six months later.

After analyzing the data on 342 patient-caregiver pairs, the investigators found that patients who had died in the hospital or an ICU experienced more physical and emotional distress and worse quality of life than those dying at home.

Among the caregivers, they determined that four of 19 caregivers (21%) of patients dying in an ICU developed PTSD, compared with six of 137 (4.4%) when death occurred in the home/hospice setting. A similar elevated risk of prolonged grief disorder was found in caregivers when patients died in the hospital, but not in an ICU.

Reference

1. Wright AA, Keating NL, Balboni TA, et al. Place of death: correlations with quality of life of patients with cancer and predictors of bereaved caregivers' mental health. J Clin Onc. Published online Sept. 13, 2010. Web: http://jco.ascopubs.org/content/early/2010/09/13/JCO.2009.26.3863.abstract. Doi:10.1200/JCO.2009.26.3863.