When a desired home death does not occur: the consequences of broken promises

J Palliat Med. 2013 Aug;16(8):875-80. doi: 10.1089/jpm.2012.0541. Epub 2013 Jun 28.


Background: Evidence shows that most people prefer to die at home; however, the majority of expected deaths occur away from home. Although home deaths require family caregiver (FCG) commitment and care, we understand very little about their experiences in this context.

Aim: The study's aim was to gain a better understanding of the experiences of FCGs when circumstances prevented a desired home death for a family member with advanced cancer.

Design: An interpretive description approach was used. Data collection involved semistructured interviews. Field notes and reflective journaling aided interpretive and analytical processes.

Setting/participants: The study was conducted in western Canada and included 18 bereaved FCGs.

Results: FCGs were committed to the promises made to care for their family member at home until death. These promises were challenged by a lack of preparedness for caregiving, difficulty accessing professional support and information, and frustration with the inadequate help they received. The events that precipitated dying family members leaving their home for hospital or hospice were unexpected and often influenced by FCGs' lack of situation-specific knowledge and ability to cope with complex caregiving responsibilities. FCGs found it extremely challenging to reconcile with breaking their promise to care at home until death and many were unable to do so.

Conclusions: FCGs' despair about not being able to keep their promise for a home death was related to complicated bereavement. Prospective studies of the experiences of FCGs who are aiming for home deaths are needed to identify both short- and long-term interventions to effectively support death at home.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Attitude to Death*
  • Bereavement
  • Canada
  • Caregivers / education
  • Caregivers / psychology*
  • Female
  • Health Knowledge, Attitudes, Practice*
  • Home Care Services / standards*
  • Hospice Care / standards*
  • Hospitalization
  • Humans
  • Interviews as Topic
  • Male
  • Middle Aged
  • Neoplasms / physiopathology
  • Neoplasms / psychology*
  • Patient Preference
  • Professional-Family Relations
  • Qualitative Research
  • Social Support*
  • Workforce
  • Young Adult