Objective-To evaluate a palliative care home support team based on an
inpatient unit. Design-Randomised controlled trial with waiting list.
Patients in the study group received the service immediately, those in
the control group received it after one month. Main comparison point
was at one month. Setting-A city of 300 000 people with a publicly fun
ded home care service and about 200 general practitioners, most of who
m provide home care. Main outcome measures-Pain and nausea levels were
measured at entry to trial and at one month, as were quality of life
for patients and care givers' health.Results-Because of early deaths,
problems with recruitment, and a low compliance rate for completion of
questionnaires, the required sample size was not attained. Conclusion
-in designing evaluations of palliative care services, investigators s
hould be prepared to deal with the following issues: attrition due to
early death, opposition to randomisation by patients and referral sour
ces, ethical problems raised by randomisation of dying patients, the a
ppropriate timing of comparison points, and difficulties of collecting
data from sick or exhausted patients and care givers. Investigators m
ay choose to evaluate a service from various perspectives using differ
ent methods: controlled trials, qualitative studies, surveys, and audi
ts. Randomised trials may prove to be impracticable for evaluation of
palliative care.