[Outpatient opiate therapy in cancer patients during their last days of life]

[Home care treatment of cancer pain patients with patient-controlled analgesia (PCA)]

BACKGROUND

Only limited data and experience with patient-controlled analgesia (PCA) in outpatients for palliative home care, related to organization, effectiveness and costs are available.

PATIENTS AND METHODS

In our retrospective study we analyzed the effectiveness, care intensity and pain reduction of 108 palliative cancer pain patients with PCA, included in a palliative home care system.

RESULTS

After equivalent conversion of the opioid doses from oral/transcutaneus to parenteral administration a dose increase was necessary in 12.9% of the patients. The pain therapy was effective until death for an average of 38.9 days (median 21 days). During 3,889 days of PCA therapy there were 76 unscheduled visits based on technical problems.

CONCLUSION

In cases of cancer pain patients with failed oral or transcutaneous opioid medication, sufficient pain reduction can be achieved with parenteral drug administration by PCA. Domestic PCA requires a lot of human and financial resources, with trained nursing services and regular house visits by physicians experienced in palliative medicine but this method is sufficient and safe to use.

[Palliative home care of cancer patients in the Leipzig region]

BACKGROUND

In many model regions of Germany, palliative home care can be improved for cancer patients over longer periods so that most of these patients could die at home. However, there is a shortage of ambulatory care for dying patients in regions without special agreements for this type of care.

METHODS

The aim of the study was to identify beneficial as well as impedimentary factors of outpatient palliative care. Therefore we interviewed 91 tumour patients and collected medical, psychosocial and sociodemographic data with standardized questionnaires.

RESULTS

Nearly half of the patients (43%) had moderate to strong pain during domestic care and felt depressed (44%) and anxious (26%). Home hospice services, social workers, and psychologists were rarely involved in home care. Ambulatory home care was often interrupted because of hospital stays.

CONCLUSION

Palliative symptom control in outpatients should be performed by qualified and interdisciplinary palliative-care teams, so that patients can receive more psychosocial support and hospital stays can be prevented.

[General practitioners' guideline for palliative care. A survey of guideline acceptance in quality circles of primary medical care]

PURPOSE

The implementation of the general practitioners' (GPs) guideline for palliative care released in 2007 with consent of the developing group was accompanied by an anonymous and voluntary survey designed to assess acceptance and feasibility of the recommendations. 60 quality circles of the GP-based care program in Hesse which are run by the PMV research group were used for guideline implementation.

MATERIAL AND METHODS

The quality of the palliative care quality circle meeting itself was checked with a standardized questionnaire (feedback, n = 473 of 515 participating GPs). After several weeks, the follow-up questioning on acceptance of the corresponding guideline was performed (n = 391 of 440 attendees) using twelve items to evaluate the guideline recommendations. The closed questions were appraised employing a Likert scale and the open questions after classifying the free text in categories.

RESULTS

96% of the respondents considered palliative medicine to be important in daily routine. The majority agreed with form and content of this CME meeting (feedback, response rate 91%). The complexity, handling, and practical relevance of the guideline were evaluated positively (response rate 88%). 82% of GPs reported that they would recommend the guideline to colleagues. Specific, practical guideline recommendations on (non)pharmacological strategies in treating dyspnea, on reducing xerostomia and on comedication in the case of opioid treatment were confirmed by 80-94% of the participants, and 75-92% rated these recommendations as practical.

CONCLUSION

The relevance of palliative care in daily routine was shown by the responses evaluating the quality circle session. The grade of acceptance of the guideline is comparable to the other GPs' guidelines with focus on pharmacotherapy. 10-13% of the respondents were not able to judge the relevance nor the practicability of selected recommendations. Future implementation should therefore consider attitude and experience with palliative care. To date, the questionnaires have not been designed to evaluate individual adherence to palliative care guideline.