Original Article The Palliative Medication Kit: An Effective Way of Extending Care in the Home for Patients Nearing Death Suzanne M. Wowchuk, R.N., B.N., M.N., 1 E. Adriana Wilson, M.D., 2 Lori Embleton, R.N., B.N., M.S.A., 3 Marcelo Garcia, M.D., C.C.F.P., 3 Mike Harlos, M.D., C.C.F.P., F.C.F.P., 3 and Harvey Max Chochinov, M.D., Ph.D., F.R.S.C. 3–5 Abstract Objective: Palliative medication kits for home use were developed in order to extend the period of time ter- minally ill patients might be cared for in their homes. Design: Kits containing medications that could be used when the oral route was lost, targeting common symptoms that result in hospital admissions, were placed in homes of terminally ill patients. Setting: Regional health authority, urban setting, community-based palliative care. Population: Patients receiving care in the community, anticipated to die within the next 2 weeks and wishing to be cared for at home as long as possible. Intervention: Kits were used when patients were experiencing symptom escalation or crisis, and the drugs to manage these were otherwise not available. Community palliative care nurses recommended when to open the kit and received verbal orders from the supervising palliative care physician for the medications to be administered. Main outcome measures: Number of kits placed and opened and the prevalence of home death in those in- stances; the number of kits placed and not opened and the prevalence of home death in those instances. Results: From 2002–2007, a total of 293 kits were placed in patients’ homes and used. Two hundred fifty-eight patients (88%) died at home, compared to 24% who died outside of an acute care setting across the entire program (w 2 ¼ 579.71; p < 0.0001). In 2006–2007, 73 kits were placed but not used. Forty-four patients (60%) died at home, compared to a program home death rate of 27% (w 2 ¼ 60.70; p < 0.0001). Conclusions: Palliative medication kits are a simple and effective way of anticipating and addressing comfort and symptom control for dying patients being cared for in the community. These kits can avert institutional crisis admissions, extend the period of time patients can be cared for in their homes and may increase the likelihood of a home death. Introduction W hile the majority of terminally ill patients would prefer to die at home, only a fraction actually do so. 1–6 Supporting patients who wish to die at home affords their wish to pass away in a familiar, nonmedical setting. The growing inclusion of noncancer patients in palliative care programs is also shaping this issue. While palliative care ex- pands beyond its traditional cancer clientele to include end- stage dementia, cardiac disease, renal failure, liver failure, and neurodegenerative illnesses, there is growing concern that this may overwhelm existing resources while impinging on current service delivery commitments. 7–9 Consequently, many countries are trying to find ways to facilitate and pro- mote home deaths in order to both meet patient expectations and to broaden the scope of potential care settings. 10–13 Several factors have been associated with a greater likeli- hood of a home death, including expressed preference to die at home, 14 strong family support for the decision to die at home, 3,10,15 the presence of an informal caregiver, 2,3,10,14–16 a nonhematologic malignancy 1,17 and the provision of pallia- tive home care and community resources. 1–3,14,18 Moreover, higher socioeconomic status, 1–4,19 being able to engage private shift nursing 1 and having a longer disease trajectory 1–3,14,15 1 College of Registered Nurses of Manitoba, Winnipeg, Canada. 2 Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia. 3 Winnipeg Regional Health Authority (WRHA) Palliative Care Program, Winnipeg, Canada. 4 Department of Psychiatry, Family Medicine, University of Manitoba, Winnipeg, Canada. 5 Manitoba Palliative Care Research Unit, CancerCare Manitoba, Winnipeg, Canada. JOURNAL OF PALLIATIVE MEDICINE Volume 12, Number 9, 2009 ª Mary Ann Liebert, Inc. DOI: 10.1089=jpm.2009.0048 797