[Effectiveness and challenges in cancer palliative home-care services: a retrospective cohort study.]

Abstract

INTRODUCTION\nManagement by the palliative care network (RLCP) has been identified as one of the major determinants of clinical appropriateness and reduction of hospital admissions in cancer patient s end of life. The patient s transition process from hospital cancer care to palliative home care is particularly frail from both a clinical and organizational point of view, requiring a multidimensional assessment (VMD) and the draft of an individual care plan (PAI). The aim of this study was to assess the impact of appropriate home-based palliative care in reducing hospitalizations, and also to identify critical issues in the patient s transition to home palliative care.\n\n\nMETHODS\nRetrospective cohort study enrolling all 375 patients listed by the Local Health Authority No.8, Veneto Region (North-East Italy), as dying of cancer in 2017 and living at home during the last six months before death.\n\n\nRESULTS\nOf the cohort considered, 40% patients had been taken into care by a palliative home-care team. These patients were more likely to die at home, less likely to be hospitalized, and spent fewer days in hospital in the last 2 months of their life than patients who were not taken into palliative network s care. Reporting of the oncologist to the Primary Care Doctor (MAP) for activation of home palliative care services takes place on average 120 days prior to death. 18.8% of these reports are not acknowledged and do not result in the MAP request for palliative home care. The time interval between the reporting of the need by the oncologist and the execution of the VMD is on average 36.8 days. The absence of the palliative care specialist during the VMD is associated with lower likelihood of being taken into care by palliative care teams (52.4% vs 97.3%) and a delay in their activation (56.3 vs 3.81 days), compared to cases in which the palliative care provider was present.\n\n\nDISCUSSION AND CONCLUSIONS\nOur findings indicate that the access to a palliative care network enables more terminally ill consenting cancer patients to spend their last days at home with relatives, reducing end-of-life hospital utilization and in-hospital deaths. There s evidence of critical issues in coordination and integration of professionals operating within the palliative network, precluding or delaying access to appropriate palliative care. These results could be useful to palliative care providers in order to review their networks and make them accessible, effective, compliant with current legislation and sustainable over time.