Home palliative care for terminal cancer patients: a survey on the final week of life

Abstract

As part of a large multicentre study on palliative care units in Italy, carried out between 1 January and 30 June 1995, we describe the place, circumstances and 'quality of death' of patients admitted to home palliative care. Data presented refer to 401 patients (67% of the 601 patients randomly selected for evaluation). Of these 401 patients 303 (76%) died at home. According to the Support Team Assessment Schedule (STAS) pain was fairly well controlled during the final week of life, while the control of other symptoms appeared to be less satisfactory. Invasive procedures were undertaken on 56% of patients, while in hospital the percentage increased to 75%. Twenty-five per cent of patients were totally pharmacologically sedated during the final 12 h of life. Neither the number of symptoms nor other factors were apparently associated with the decision to sedate the patient. The wide variations in the frequency of sedation among centres suggest that the choice to sedate the patient may reflect the provider's behaviour or services' policy rather than the patients' preference or needs. The definition of common criteria and guidelines for sedation of patients should be one of the topics for discussion among palliative care teams.

Palliative Sedation in Advanced Cancer Patients Followed at Home: A Retrospective Analysis

“…It is likely that this implies a lack of consensus on definition of PS among the centers involved. 11 The frequency found in the present study also seems to be lower than the 20%e50% rate reported by hospitalbased palliative care units or hospice, 12e15 with the highest rate in acute care units. 16 It is likely that hospitalized patients tend to have a greater symptom burden than those who remain at home or patients are admitted to hospital as an emergency because of the development of refractory symptoms close to death.…”

The imPaCT study: a randomised controlled trial to evaluate a hospital palliative care team

“…The usual course in such patients is one of deterioration in physical symptoms (Coyle et al, 1990;Ventafridda et al, 1990, Peruselli et al, 1999. There was a consistent direction to the comparisons of the main outcome measures and satisfaction scores in favour of 'full-PCT', though the differences between the groups were not significant.…”

How Do Cancer Patients Receiving Palliative Care at Home Die? A Descriptive Study

“…These figures appear more relevant in comparison with previous experiences. About 12%e25% of patients have been reported to be sedated before dying, 7,19 although defined criteria and information about the intensity of palliative home care activity were lacking. The relatively higher percentage of sedation at home may reflect the quality and the strength of the palliative home care teams selected for this study compared with conventional care.…”

“…2 In Italy, death at home was very frequent in early prospective studies, occurring in as many as 86% of deaths; 6 multivariate analysis showed that a higher degree of family support was associated with home death. In a large multicenter study of palliative care units, mostly home care programs, 76% of patients died at home, 7 which was the desired place in 90% of patients. From the historical perspective, it is notable that these studies were performed in a period when hospices in Italy were largely unavailable and palliative care services were based only on home care.…”

“…About 25% of patients followed at home presented with severe symptom intensity, for which home care was practically impossible, suggesting that the best option would probably be the admission to an inpatient hospice. 7 Regardless of the complexity of factors influencing the place of death of cancer patients, no study, to the best of our knowledge, has ever assessed how cancer patients die at home from a clinical and environmental viewpoint. Previous articles have analyzed conceptual models of the quality of death and several domains have been identified to conceptualize the quality of death.…”