SUPPORT NEEDS IN THE LAST YEAR OF LIFE - PATIENT AND CARER DILEMMAS

The aim of this study was to identify needs for support and problems i n the introduction of support to terminally ill patients and their car ers. The design involved semistructured interviews with patients and c arers as well as a survey of general practitioners' (GPs) views, and t ook place in GP practices and homes of patients in Cambridgeshire. The subjects comprised 43 terminally ill patients, 30 carers, 80 GPs and 13 of their GP partners. The main outcome measures were quantitative d ata about additional help required and qualitative data on reasons for reluctance to seek help. Needs for help with transport, personal care and housework were identified. Carers may also need reassurance from health professionals. The need for outside help may al times conflict with the need to preserve independence, dignity and familiar aspects o f life. Sometimes carers may feel that there is need for more help, bu t that this conflicts with patients' wishes. There may also be relucta nce to seek help because of a perceived lack of resources and professi onals' time. In conclusion, an increase in services is necessary but n ot sufficient to meet patients' needs fully. Services should be introd uced in ways that help patients to preserve independence, dignity and familiar aspects of life. The perception of accessibility to health pr ofessionals may need to be improved. Carers' needs should be assessed separately from patients' needs.