PALLIATIVE CARE AT HOME - AN AUDIT OF CANCER DEATHS IN GRAMPIAN REGION

Background. Ninety per cent of the last year of life of cancer patient s is spent at home. Some studies have suggested that care in this sett ing is often suboptimal. Information on the standard of palliative car e delivered at home by general practitioners (GPs) and their teams is limited and clarification of the problems faced is needed. Aim. To aud it the home-based palliative care of patients dying of cancer. Method. Matched postal questionnaires were sent to the GPs and nurses of 1086 successive patients dying of cancer in whatever setting in the Grampi an region of Scotland some six weeks after the death to establish the professionals' perception of symptom control, communication problems, use of services, and information given to patients and relatives. Resu lts. Response rates were 88.8% for GPs (964 out of 1086) and 87.1% for nurses (325 out of 375 that were passed on to nurses). Two-thirds of patients received palliative care at home. Pain was poorly controlled in 15.7%, and poor control of other symptoms ranged from 13.8% (nausea and vomiting) to 21% (depression and dyspnoea). Communication difficu lties were present in 93.7% of cases, although only 5.2% of these were of a major nature. District nurses were involved in 76.7% of cases an d Macmillan nurses in 28.0%. Twenty-six per cent of referrals to distr ict nurses were assessed as being late in the course of the illness. P atients were fully informed about the diagnosis in 66.3% of cases and about the prognosis in 55.4%. General practitioners were more likely t o report the presence of communication problems between themselves and the patient (when compared with nurses: 43.9% versus 28.0%), more lik ely to report that patients were 'not at all informed' about self-help groups (57.5% versus 36.3%), and were less likely to report the invol vement of occupational therapists (21.8% versus 39.7%). Conclusions. L evels of reporting of poor symptom control by professionals was much l ower than levels reported by relatives in other studies, but there was no difference between the reporting of GPs and nurses. However, a num ber of areas were identified where care could be enhanced by improved teamwork and further education and training in symptom control, as wel l as in communication, use of services, and information provision.