Home Hospitalization in Palliative Care for Advanced Cancer and Dementia: A Systematic Review

Abstract

Context

Home hospitalization (HHOSP) is an alternative care model aimed at alleviating pressure on healthcare systems and catering to the increasing patient population. It aligns with the preference for home-based palliative care (PALC) and end-of-life care.

Objectives

This study systematically reviewed the literature to evaluate HHOSP's role in PALC, focusing on hospital readmissions, length of stay, patient and caregiver safety and satisfaction, place of death, and overall survival.

Methods

A systematic search was conducted in PubMed, Scopus, and Web of Science databases from 2013 to 2023. Participants: patients of any age or gender diagnosed with advanced, metastatic, or incurable cancer or advanced dementia. Intervention: HHOSP. Comparator: usual care. Outcomes: hospital readmissions, length of stay, patient and caregiver safety and satisfaction, place of death, and overall survival. The risk of bias was assessed using Cochrane tools.

Results

Six studies with 843 participants from Denmark, France, Spain, and Israel were included. The overall risk of bias was moderate to high. HHOSP reduced hospital readmissions, with 42.2%–91% of patients avoiding further hospitalizations. Caregivers reported feeling safe and satisfied with HHOSP, experiencing reduced burden. Most patients died at home (52.2%–75%). Median overall survival ranged from 28 days–11.2 months.

Conclusion

The findings highlight HHOSP's potential as an alternative for delivering PALC, reducing hospital readmissions, and improving patient and caregiver satisfaction. Despite heterogeneity in study designs and outcomes, HHOSP aligns with patient and caregiver preferences, enhancing the quality of end-of-life care. Further standardized research is needed to optimize HHOSP implementation.