A palliative-care intervention and death at home: a cluster randomised trial

Background The Palliative Medicine Unit at University Hospital of Trondheim , Norway, started an intervention programme that aims to enable patients to spend more time at home and die there if they prefer. Close cooperation wa s needed with the community health-care professionals, who acted as the pri ncipal formal caregivers, and a multidisciplinary consultant team coordinat ed the care. We did a cluster randomised trial to assess the intervention's effectiveness compared with conventional care Methods Community health-care districts in and around Trondheim, Norway, we re defined as the clusters to be randomised. We enrolled 434 patients (235 assigned intervention and 199 conventional care [controls]) in these distri cts who had incurable malignant disease and an expected survival of 2-9 mon ths. Main outcomes were place of death and time spent in institutions in th e last month of life. Findings 395 patients died. Of these, more intervention patients than contr ols died at home (54 [25%] vs 26 [15%], p<0.05). The time spent at home was not significantly increased, although intervention patients spent a smalle r proportion of time in nursing homes in the last month of life than did co ntrols (7.2 vs 14.6%, p<0.05). Hospital use was similar in the two groups. Interpretation The palliative-care intervention enabled more patients to di e at home. More resources for care in the home (palliative care training an d staff) and an increased focus on use of nursing homes would be necessary, however, to increase time at home and reduce hospital admissions.