Hospital at home: home-based end-of-life care.

Background A number of countries have invested in health services to provide care at home to people with a terminal illness who wish to die at home. The preferences of the general public and people with a terminal illness seem to support this, as most people indicate that they would prefer to receive end-of-life care at home. Objectives We systematically reviewed the literature to see if the provision of end-of-life home-based care reduced the likelihood of dying in hospital and what effect this has on patients’ and caregivers’ satisfaction and health service costs, compared with being admitted to a hospital or hospice. This is the fourth update of the original review. Study characteristics We searched the literature until April 2015 and found no new trials for this update. We found four trials for the previous updates. Main results We included four trials in our review and report that people receiving end-of-life care at home are more likely to die at home. It is unclear whether home-based end-of-life care increases or decreases the probability of being admitted to hospital. Admission to hospital while receiving home-based end-of-life care varied between trials. People who receive end-of-life care at home may be slightly more satisfied after one month and less satisfied after six months. It is unclear whether home-based end-of-life care reduces or increases caregiver burden. Healthcare costs are uncertain, and no data on costs to participants and their families were reported. Authors' conclusions People who receive end-of-life care at home are more likely to die at home. There were few data on the impact of home-based end-oflife services on family members and lay caregivers