Aim of
investigation: Since 1995 three specialised palliative care units, two
hospices, Home-Care-Berlin, nursing services and volunteers cooperate in a
structure similar to a network. Aim of this study was to evaluate the role of
different palliative care facilities in terminal situations, consider the pros
and cons of in- and outpatients palliative care and give recommendations for
further implementations.
Methods: The data
of about 1600 palliative care patients treated in different palliative care
facilities in 1999 were analysed in relation to diagnoses, days of hospitalisation,
mortality, location of death, duration and treatment modalities. On the base of
these data criteria for the structure, educational needs and improvement in the
quality of palliative care were developed.
Results: More then
60% of the patients with advanced cancer could remain at home even in the final
phase of their disease. 17% died in one of the hospices and less then 20% spent
the last days in hospital. The realisation of good palliative care at home
needs high competence, close cooperation and sensitive communication.
Educational initiatives and the regular exchange of experiences in a Palliative
Care Quality Circle were helpful
to solve problems and improve palliative care while systematic teaching
in palliative medicine still is lacking.
Conclusions:
Educational efforts must be made to increase the acceptance of palliative care
principles in the ambulatory setting. Networks and Palliative Care Quality
Circles are needed to overcome discrepancies in in- and outpatients palliative
care.