F. De Conno

Effect of home care on the place of death of advanced cancer patients.

This study presents a prospective evaluation of the home care programme for patients with advanced cancer at the National Cancer Institute of Milan. Demographic, psychosocial and physical variables were evaluated. The Therapy Impact Questionnaire was used for symptom and quality of life assessment. The association of clinical and demographic variables with the place of death was investigated, considering that the aim of the home care programme is to follow up patients until death in their houses. Eighty-six per cent (86%) of patients died at home and 14% in hospitals. Multivariate analysis showed that only a higher degree of family support was associated with home death. Several changes in symptoms and quality of life items scores were seen, pain improved while physical debility and cognitive functions worsened throughout the home care duration to death. High intensity pain and dyspnoea were still present in, respectively, 23.8 and 15.3% of patients in the last week of life. Psychological distress was high at the end of life and did not seem to be affected by treatment. Home care is a feasible alternative for implementing palliative care in a selected population of patients with advanced cancer. Palliation of physical symptoms is more easily achieved than the control of psychological suffering. Family and economical issues implied by home care models should be part of the discussion in implementing palliative care for advanced cancer patients.

Palliative care research.

Most of the research in palliative medicine is of a descriptive nature. Clinical practice is based upon clinical experience rather than upon research. The level of appropriate research reduces the chance for improvement of palliative care. Ethical and methodological obstacles seem to be prominent in palliative care research. The Declaration of Helsinki is generally accepted as an ethical code of practice for clinical research and it also applies to palliative care. In order to obtain reliable data, standardisation of data collection is needed. Improvement of quality of life is the primary endpoint in most studies in palliative care. The existing validated quality of life instruments such as the European Organization for Research and Treatment of Cancer (EORTC) quality of life (QLQ)-C30 can be used until the patient is too sick to complete the questionnaire. New approaches are needed and must be developed for the dying patients. Palliative care research needs proper funding; specific programmes supporting research on a European level are needed. The European Association for Palliative Care (EAPC) is capable of conducting and coordinating collaborative research in palliative care on a European level.

1374 Virtual reality and computer training in oncological nursing: Experience and prospects

In finding a balance between innovation and organization, training must be considered the main requirement in coping with the present technological advance. Oncological nursing requires continuous updating even through new technologies. Following our two previous studies for ECCO 6 and 7 on computer and multimedia training respectively, now we look at Virtual Reality, a computer tool to look at and interact with objects which do not exist or cannot be reached in the real world. Virtual Reality allows real or imaginary worlds to be explored without fixed procedures. It is now possible to train nursing staff by simulating activities, which are impossible or risky in reality, e.g.: invasive therapy or emergency situations. Virtual Reality is a valid teaching instrument in nursing practice. Various experiences applied to the training of oncological nurses and carried out by I.N.T. and Ratio UNO are illustrated, particularly: (1) physiopathology of symptoms, (2) main pharmacological mechanisms in palliative care, (3) the care and treatment of the terminally ill and relative teaching skills. A course will be proposed on the general principles of computers, multimedia and Virtual Reality so that a sound basis for the application of these new techniques for oncological nursing can be established.