Clinical findings and recommendations made during home visits by a palliative care specialist physician

Abstract

Little has been reported regarding the nature of home visits by palliative care specialist physicians to assist in the management of complex cases. We determined the characteristics, actionable clinical findings and recommendations made during consecutive home visits conducted by a specialist physician for patients registered with a community palliative care service. Patient demographic information and clinical records were reviewed. Ninety-one patients received a total of 104 home and residential facility visits. Median patient age was 59 (Q1-Q3, 43-72). Ten children (under the age of 14) received a total of 15 visits. Seventy-three patients (80%) had a cancer diagnosis. Median visit duration was 60 min (Q1-Q3, 45-60). The major actionable clinical findings were pain (120), gastrointestinal (115), neuropsychiatric (58), mouth and skin (33) and respiratory (29). One-third of recommendations involved changes in analgesia regimen (opioids 67, adjuvants 44). The specialist physician home visit resulted in multiple patient care recommendations. This information may help palliative care programmes improve their care for patients and families in the community.

Where do patients known to a community palliative care service die?

“…Government initiatives including the End-of-Life Strategy in England and the Implementation of the Palliative Care Strategy in Wales strive to improve equitably the quality of care received by patients, raising expectations among patients and their families, and professionals 3 4. As a consequence there is an increased expectation of high-quality palliative care to patients in the community by the recipients of care and other healthcare professionals 5. Services presently operate in distinct areas with changing demographic trends and a challenging financial climate 6.…”