Q: One of my friends is dying of cancer and I was surprised to hear that she has been sent home to die. The doctors say she will only live about a week. Is this normal procedure in Canada? How can her husband and adult son manage? She has a lot of pain and needs powerful drugs to control it.
A: Most people find it difficult to discuss what will happen in their final days, but it is important to let your relatives know what your wishes are. Most people prefer to die at home in familiar surroundings and with their loved ones and pets present. In most cases, even with terminal cancer, it is quite possible with the appropriate help.
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A recent study in Toronto, published by Sarah Hales and associates in the Journal of Pain and Symptom Management, gave caregivers of terminally ill patients a questionnaire called Quality of Dying and Death.
The responses showed that the majority of people thought the person had died comfortably and free of pain.
Home death was associated with better overall quality of dying and death and better symptom control and death preparation than hospital or hospice/palliative care deaths.
Interestingly, the study also showed that despite the availability of funded home-based palliative care in the Toronto area, only 30 percent of the cancer deaths they studied were at the patient’s home.
Forty percent of them were in an inpatient hospice or palliative care unit while 28 percent were in an acute care hospital setting.
Even with advance planning and the patient leaving written instructions that they wish to die at home, the relatives are sometimes not up to the task, either physically or mentally.
There may not be any relatives or perhaps they do not live close enough or have young children to look after as well.
Some may be in denial that the person is terminally ill and hope for some last minute miracle cure.
Many people are simply not aware that free help is available and intravenous drips, regular morphine administration and other painkillers and sedatives will not be a problem for the caregiver.
I also wonder whether most people realize that patients dying of cancer are often still able to take care of themselves to some extent, such as being able to walk to the bathroom with help and communicate, until about the last week of life.
If the person no longer wishes to eat, this is a sign that the end is near. Don’t force them because this is nature’s way of making the final days more comfortable.
