Transforming End-of-Life Care: Impact of the “ Melhor em Casa ” Home-Based Palliative Care Program in Brazil

Abstract

Background:

Palliative care (PC) is essential for managing symptoms and improving the quality of life for cancer patients. In Brazil, the “Melhor em Casa” (“Better at Home”) program offers interdisciplinary home-based care. The SAD-Caratinga Program (SAD-CP) in Minas Gerais has provided care to patients with cancer since 2013.

Objectives:

This study aimed to evaluate the SAD-CP, focusing on sociodemographic and clinical data of cancer patients, symptoms, survival, number of hospitalizations, and place of death.

Methods:

A retrospective, cross-sectional, quantitative analysis was conducted on data from 471 consecutive oncology patients who died while under the program’s care between 2013 and 2023. Demographic, clinical, and service data were analyzed using descriptive statistics, Kaplan–Meier survival estimates, chi-square, and Kruskal–Wallis tests.

Results:

The median age was 70 years, with 52.9% male patients and stage IV (57.8%). Pain was the most reported symptom (94.7%), followed by dyspnea (77.1%) and hypersomnolence (69.2%). Median survival was 48 days, with significant variation by cancer type. Notably, 468/471 (99.4%) patients died at home. The program demonstrated effective symptom management, as only three patients (0.6%) patients were hospitalized, and there were minimal emergency visits (0.08 visits/day).

Conclusion:

This interdisciplinary intensive home-based PC program improved patient symptom control and dramatically reduced hospital deaths. Future research should explore scalability and long-term outcomes in diverse populations.