Comparison of terminally ill cancer- vs. non-cancer patients in specialized palliative home care in Germany – a single service analysis

Abstract

BackgroundPalliative care (PC) is no longer offered with preference to cancer patients (CA), but also to patients with non-malignant, progressive diseases. Taking current death statistics into account, PC in Europe will face a growing number of patients dying from non-cancer diseases (NCA). More insights into specialized palliative home care (SPHC) in NCAs are needed.MethodsRetrospective analysis and group comparisons between CAs and NCAs of anonymous data of all patients cared for between December 2009 and June 2012 by one SPHC team in Germany. Patient-, disease- and care-related data are documented in clinical routine by specialized PC physicians and nurses in the Information System Palliative Care 3.0 ® (ISPC®).ResultsOverall, 502 patients were cared for by the SPHC team; from 387 patients comprehensive data sets were documented. These 387 data sets (CA: N = 300, 77.5 % and NCA: N = 87, 22.5 %) are used for further analysis here. NCAs were significantly older (81 vs. 73 years; p < .001), than CAs and most often suffered from diseases of the nervous system (40 %). They needed significantly more assistance with defecation (87 vs. 74 %; p < .001) and urination (47 vs. 29 %; p < .001) and were more often affected from impaired vigilance (30 vs. 11 %; p < .001) than CAs. A by trend higher proportion of NCAs died within one day after admission to palliative home care (12 vs. 5 %; p < .05) and a smaller proportion was re-admitted to hospital during home care (6 vs. 20 %; p < .001). NCAs died predominantly in nursing homes (50 vs. 20 %; p < .001).ConclusionsAlthough the proportion of NCAs was relatively high in this study, the access to PC services seems to takes place late in the disease trajectory, as demonstrated by the lower survival rate for NCAs. Nevertheless, the results show, that NCAs PC needs are as complex and intense as in CAs.

<p>Describing Complexity in Palliative Home Care Through HexCom: A Cross-Sectional, Multicenter Study</p>

“…29 We also know that the needs of cancer patients are radically different from those of terminal patients with organ failure. 19,20,30,31 Waller observed physical complexity in 51% of participants, practical social/family complexity in 33%, and high spiritual complexity in 8.8%. 32 Waller also observed high psychological/emotional complexity in 38.8% of patients.…”

Optimising compassionate nursing care at the end of life in hospital settings

“…However, it has been argued that demonstrating compassion for a patient may be seen as being supererogatory or that which is ‘morally good but superfluous to need’ (Sinclair et al, , ; Stiel et al, ). This may explain why nurses working under busy clinical workloads focus on physical care and ignore the relational aspects of care.…”

Analyse der medizinischen Versorgung onkologischer und nichtonkologischer Palliativpatienten in der spezialisierten ambulanten Palliativversorgung (SAPV)

“…[9]. In der Studie von Stiel et al hatten Nichttumorpatienten hingegen häufiger eine eingeschränkte Vigilanz im Vergleich zu Tumorpatienten (30 % vs. 11 %) und benötigten häufiger eine Unterstützung der Blasenfunktion durch einen Dauerkatheter (29 % vs. 47 %) sowie Unterstützung bei der Defäkation (87 % vs. 74 %) [6]. Ob und inwiefern die bisherigen Behandlungs-und Versorgungskonzepte der SAPV aufgrund derartiger Unterschiede der beiden Patientengruppen eine Anpassung erforderlich machen, sollte durch weitere Untersuchungen geprüft werden.…”

“…Neben der Behandlung von Tumorpatienten spielt die Versorgung nichtonkologischer Patienten in der Palliativmedizin von Jahr zu Jahr zunehmend eine immer größer werdende Rolle [5]. Inwiefern sich die ambulante palliative Versorgung dieser beiden Patientengruppen unterscheidet, wurde bislang nur vereinzelt untersucht [6,7] Einzelnen Tumorentitäten wurden organ-oder fachrichtungsspezifisch unterteilt und zusammengefasst. Nichttumordiagnosen wurden organspezifisch unterteilt und zusammengefasst.…”