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Palliative Medicine
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Inadequacies of care in far advanced cancer patients: a comparison between home and hospital in Italy

Franco Toscani

Sezione di Terapia del Dolore et Cure Palliative

Claudio Mancini

Direzione Sanitaria, Presidio Ospedaliero Cremonese, Cremona

A previous survey of patients treated by our palliative care service showed that most patients with advanced cancer wished to be cared for at home. This is in contrast with the fact that these patients were increasingly frequently hospitalized because of their belief that a hospital, in spite of its shortcomings, is the place where medical and nursing care are more advanced.

A prospective survey was carried out on 120 advanced cancer patients under the palliative care service of the Cremona Hospital, Italy. The survey recorded all the inadequacies of their care from the time patients were seen until death occurred. Five times as many inadequacies occurred in hospital than at home (an average of 4.4 ± 5.0 every 100 days against 0.8 ± 2.0 every 100 days; p < 10E -6). The most frequent inadequacies of care at home were caused by both narcotic and drug misuse, and unjustified alterations in the therapy; in the hospital they were related to therapeutic regimes and failure to report new symptoms. These data support the view that general hospital care in Italy today does not necessarily provide the best solutions to the problems of the terminally ill patient. A palliative care programme should include the option of organized home care.

Key Words: home care • palliative care • terminal patients

Palliative Medicine, Vol. 4, No. 1, 31-36 (1990)
DOI: 10.1177/026921639000400107
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