A comparison of hospice and hospital care for people who die: views of the surviving spouse

To compare the quality of inpatient care for dying people in St Christopher's Hospice, London and nearby hospitals in 1994 and make comparisons with earlier studies of the same setting, interviews were undertaken with spouses of people who had died from cancer in these settings, matched by age and sex.

The subjects comprised 66 people who had died in 1994, 33 of whom had died in the hospice, 33 in local hospitals. The mean age was 70.2, 61 % were male.

The hospice group were more likely to know that they were dying and less likely to be admitted as emergencies. Treatment for pain, breathlessness and nausea from both sources provided relief in almost all cases. Most information about the illness was given by hospital doctors before hospice care occurred. Where it occurred, communication by hospice staff was judged better than that by hospital doctors. Staff in hospitals were more likely to be judged 'very busy'. Hospice respondents were less likely to want improvements, and more likely to judge the institution as being 'like a family'. Earlier studies had shown a trend for symptom control to have improved in hospitals but for difference in the psychosocial climate to favour the hospice. By 1994, this latter difference was still obtained.

We stress the role of hospital staff and general practitioners in helping patients accept a terminal prognosis, so that better-planned care can proceed. The busy public atmosphere of some hospital wards may not be conducive to the good care of dying people.