A comparison of hospice and conventional care

Interviews with relatives and others who knew a group of people dying of cancer in England are reported. The bulk of the paper compares 45 such patients who received hospice care with 126 who received conventional care. The sampling procedure showed that 2.9% of people aged 15 or over at death died in a hospice, and 6.9% received some form of hospice service. The hospice patients differed in several ways from other cancer patients. They had fewer conditions other than cancer recorded on the death certificate, were believed to be more religious and were more likely to suffer from a variety of symptoms and restrictions, including pain. Hospice patients were reported more likely to know that they were dying and respondents' levels of satisfaction with hospice home nursing and in-patient hospice care were significantly higher than for other forms of care. Hospice home nurses were found to have adopted a more advisory approach to nursing care than other home nurses who focused more on practical care. When final admissions were considered, in-patient hospice care involved fewer medical interventions and, in the last year of life, those receiving hospice services were less likely to have an operation. There were few differences between the two groups in what happened at the time of death, although for in-patient deaths, respondents judged the staff of hospices to be more understanding. The relatives of hospice patients were more likely to be visited by a nurse at home after the death. Few differences in bereavement reaction were found, but those that there were suggested that respondents for the hospice group were adjusting better. The study covered 14 different hospice in-patient units.