Case Presentation of Two Patients Compassionately Discharged, from Hospital to Home, Who Did Not Achieve Their Desired Home Death.

Abstract

The objective of this case presentation is to identify factors that hinder home deaths after patients have been compassionately discharged from the hospital. It aims to shed light on modifiable factors that could facilitate a home death. Compassionate discharges differ from routine discharges as they are done to support the wishes of terminally ill patients to pass on at home. The two cases selected for detailed analysis were unique in our cohort; they were the only patients admitted to an inpatient hospice after being compassionately discharged to their homes. This study excluded patients who were readmitted to an acute hospital setting for further treatment trials, as their care objectives had changed. A retrospective analysis of medical notes identified several factors associated with the patient's inability to achieve a desired home death. These included a significant increase in nursing needs compared to the pre-admission status, the substantial psychological burden on families caring for a dying relative at home, and the absence of adaptable and sustainable care plans. Therefore, a successful compassionate discharge requires the provision of caregiver training and psychological support to families both before and after discharge. Moreover, healthcare providers must collaborate with families to develop flexible care plans that are sufficiently robust to manage the unpredictable prognoses of patients.