DYING FROM CANCER IN COMMUNITY HOSPITALS OR A HOSPICE - CLOSEST LAY CARERS PERCEPTIONS

Background. Despite there being around 400 community hospitals in the United Kingdom, there is little published research on the quality of s ervice provided by these hospitals. Aim. To compare the quality of ter minal cancer care in community hospitals with a hospice as assessed by patients' closest lay carer (relative or friend). Method. Structured interview (or questionnaire based on the interview proforma) with clos est lay carers of all patients dying over one year in 12 community hos pitals in east Devon and a purpose-built hospice in the city of Exeter . Results. A total of 292 cases (176 in community hospitals and 116 in a hospice) were identified, resulting in 238 carers being eligible fo r interview or questionnaire survey. Overall, 106 successful interview s and 55 questionnaires were completed, giving a response rate of 67.6 %. Carers gave a near unanimous vote of excellence for the total care given by the hospice, while around 40% of carers of patients in commun ity hospitals considered that improvements were possible. Community ho spitals attracted more negative comments than hospices, with criticism being directed at problems of communication, lack of nursing staff an d lack of support in bereavement. Carers of hospice patients were sign ificantly more likely to be present at the time of death than those of community hospital patients [45/70 (64%) vs. 31/89 (35%); chi(2) = 13 .6, P<0.001], an observation possibly because nursing staff in communi ty hospitals are less experienced at dealing with terminally ill patie nts and such hospitals have fewer adequate facilities. Conclusions. La y carers indicated great satisfaction with care given in the hospice a nd less satisfaction with care given in the community hospitals. Howev er, the community hospitals are non-specialist units with far lower le vels of trained staff. Improvements in terms of the communication skil ls of doctors and nurses, specific training for nurses in palliative c are, and structured bereavement care could be made without necessarily increasing staffing numbers.