The National Tumor Association Foundation (ANT): A 30 year old model of home palliative care

Abstract

BackgroundModels of palliative care delivery develop within a social, cultural, and political context. This paper describes the 30-year history of the National Tumor Association (ANT), a palliative care organization founded in the Italian province of Bologna, focusing on this model of home care for palliative cancer patients and on its evaluation.MethodsData were collected from the 1986-2008 ANT archives and documents from the Emilia-Romagna Region Health Department, Italy. Outcomes of interest were changed in: number of patients served, performance status at admission (Karnofsky Performance Status score [KPS]), length of participation in the program (days of care provided), place of death (home vs. hospital/hospice), and satisfaction with care. Statistical methods included linear and quadratic regressions. A linear and a quadratic regressions were generated; the independent variable was the year, while the dependent one was the number of patients from 1986 to 2008. Two linear regressions were generated for patients died at home and in the hospital, respectively. For each regression, the R square, the unstandardized and standardized coefficients and related P-values were estimated.ResultsThe number of patients served by ANT has increased continuously from 131 (1986) to a cumulative total of 69,336 patients (2008), at a steady rate of approximately 121 additional patients per year and with no significant gender difference. The annual number of home visits increased from 6,357 (1985) to 904,782 (2008). More ANT patients died at home than in hospice or hospital; this proportion increased from 60% (1987) to 80% (2007). The rate of growth in the number of patients dying in hospital/hospice was approximately 40 patients/year (p < 0.01), vs. approximately 177 patients/year for patients who died at home. The percentage of patients with KPS < 40 at admission decreased from 70% (2003) to 30% (2008); the percentage of patients with KPS > 40 increased. Mean days of care for patients with KPS > 40 exceeded mean days for patients with KPS < 40 (p < 0.001). Patients and caregivers reported high satisfaction with care in each year of assessment; in 2008, among 187 interviewed caregivers, 95% judged the quality of doctors' assistance, and 91% judged the quality of nurses' assistance, to be "optimal."ConclusionsThe ANT home care model of palliative care delivery has been well-received, with progressively growing numbers of patients served. It has resulted in a greater proportion of home deaths and in patients' accessing palliative care at an earlier point in the disease trajectory. Changes in ANT chronicle palliative care trends in general.

Clinical and demographic factors associated to the place of death in advanced cancer patients assisted at home in Italy

“…45 This figure is higher than the average of cancer patients who die at home in North East Italy. 31,48 In this study five variables were associated with athome death using a univariate analysis.…”

“…Following a recent law on palliative care organization, the social awareness of the need for early palliative approach in advanced cancer patients is spreading in Italy. 45,57 In fact, a trend of early palliative care in cancer patients has been observed over the last few years. 45 However, our study did not show a significant relationship between the duration of home care service and the place of death.…”

“…45,57 In fact, a trend of early palliative care in cancer patients has been observed over the last few years. 45 However, our study did not show a significant relationship between the duration of home care service and the place of death. 19,56 On the contrary, the number of visits by physicians in the last 30 days favored the home as the place of death, rather than the hospital or hospice.…”

“…19,45,56 An increasing palliative culture in Italy may also have a role in the longer duration of home care. Following a recent law on palliative care organization, the social awareness of the need for early palliative approach in advanced cancer patients is spreading in Italy.…”

“…7,19,44 In this retrospective study, some variables have been evaluated in a group of patients with advanced cancer who have received care from ANT, an at-home palliative care service working in Italy for 35 years. 45 All patients under this study lived in Bologna, a city in North Italy where public and private organizations have been working for a long time providing palliative care completely free of charge. 46,47 In order to guarantee an effective palliative/supportive care, an extensive at-home care service and three residential hospices are available in this area.…”