Study of 29,000 patients shows that home nursing improves care at the end of life

A new study published today provides strong evidence that a well known form of home-based nursing care reduces the need for emergency hospital care at the end of life, and helps more people to die at home.

The research, which was undertaken by the Nuffield Trust, studied over 29,000 people who received care from the Marie Curie Nursing Service (MCNS), comparing their outcomes to a ‘control’ group of people with similar characteristics who did not receive care from the Marie Curie Nursing Service.

It found that more than three quarters of those who received Marie Curie Nursing Service care died at home, compared to 35 per cent of those who did not receive the service. The findings are striking given that surveys show that the majority of people would prefer to die at home.

In an increasingly tight financial climate for public services, we need to identify ways to maintain or improve the quality and experience of care patients receive, without large additional costs Dr Martin Bardsley, Director of Research, Nuffield Trust

The researchers went on to compare how often people went to hospital as an emergency, with the rate for Marie Curie patients found to be one third of that for the matched controls.

Though end of life care is often associated with cancer patients, the study also showed that these benefits were found in patients without a recent history of cancer – in fact they were larger, a point worth noting given that people who do not have a cancer diagnosis often face barriers to accessing end of life care services.

The findings are published in: The impact of the Marie Curie Nursing Service on place of death and hospital use at the end of life, but to summarise:

• More than three quarters (77 per cent) of those who received Marie Curie care died at home, compared to 35 per cent of the 'control' group. Eight per cent of the Marie Curie patients died in hospital compared to 42 per cent of the control group;

• People who received Marie Curie care were much less likely to use all forms of hospital care than the 'control' group. 12 per cent of Marie Curie patients had an emergency admission at the end of life, compared to 35 per cent of the control group, while eight per cent had an A&E attendance compared to 29 per cent of controls;

• The impact of the Marie Curie Nursing Service was even greater in those patients who did not have a history of cancer. More died at home and there was a lower use of emergency hospital care, compared to people with cancer;

• Total hospital costs for those who received Marie Curie care were £1,140 lower per patient than for matched controls from the first contact with the service until death. Reduced costs of emergency hospital admissions accounted for 75 per cent of this difference. There was also a significantly greater reduction in overall hospital costs among cases with no history of cancer (-£1,475), compared to those with cancer (-£1,044). However, these cost savings would need to be offset against other costs, including the nursing service itself and possible increased use of other services, in order to evaluate the ‘whole system’ impact on the cost of care.

Dr Martin Bardsley, Nuffield Trust Director of Research, and a member of the evaluation team, said:

"In an increasingly tight financial climate for public services, we need to identify ways to 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."

Dr Jane Collins, Chief Executive, Marie Curie Cancer Care added:

“Most people want to be cared for at home at the end of their lives and don’t want to spend their final days in hospital. We now have strong evidence to show just what a difference the Marie Curie Nursing Service can make to fulfilling people’s last wishes. Unfortunately the provision of good quality of end of life care varies greatly and not everyone is able to access services.

“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.”