SERVICES GIVEN AND HELP PERCEIVED DURING HOME CARE FOR TERMINAL CANCER

Separate accounts of care were recorded weekly from staff, patients an d relatives in a randomised sample of patients with terminal cancer re ferred to a home care service with readily available beds. Various ser vices were involved but nurses made most contacts, 3.0 visits and 2.4 phone calls weekly, rising sharply in the last week. General practitio ners averaged 0.4 visits/week but their considerable variation evoked either praise or criticism. Maintaining contact, giving explanations a nd support were reported to help as often as physical treatments and p ractical nursing, although staff's and recipients' accounts differed s lightly. Help succeeded for many problems, but weakness was common, of ten grew worse and led to more admissions than pain. Difficulties in r elieving fatigue and strain in relatives also curtailed home care. Sub sequent home care team reorganisation to strengthen linkage between pa rticular nurses and patients and the improvement of day care services were associated with successive but modest rises from the original 27% to 34% of patients dying at home. Implications of the results for ser vices and skills required for home care are discussed, noting the prob lems that deserve further attention.