Dr Alberto Alonso Babarro, Palliative Care Unit, Hospital Universitario La Paz, Madrid, Spain, introduces a research study that was selected as ‘Editor’s choice’ in the January edition of Palliative Medicine.
We are very grateful and honoured that our article was nominated as ‘Editor’s choice’ for the January 2013 edition of Palliative Medicine (Alonso-Babarro et al, 2013).1 I would like to make a special mention of the great team that made this possible. I believe that behind any clinical research there are a great many people who contribute in very different ways to make the study possible. In this case, the study acknowledges the difficult work of palliative home care teams.
In 2006, the Region of Madrid in Spain initiated an integrated palliative care programme aimed at providing universal access to all levels of palliative care services to the community. Until that year, resource distribution was highly irregular among the different regional healthcare areas. At that time, our work group saw a window of opportunity to design a population-based study comparing two metropolitan areas in the region, measuring inpatient death and use of hospital resources, to evaluate the benefits of an established palliative home care team.
We had to overcome many barriers to conduct our study. The main problems were to obtain the appropriate authorisation from the Madrid Regional Government and the Data Protection Agency, and to manage quite a few different data resources. Our study results found that the frequency of inpatient hospital deaths, and use of hospital resources during the last two months of life, were significantly lower in the metropolitan area that had a fully-established palliative home care team. On the other hand, our study represents the first population-based study to analyse place of death for cancer patients in Spain.
The World Health Organization and other leading international organisations have highlighted the importance of investigating the factors associated with the place of death in different regions around the world. Research that demonstrates the effectiveness of palliative care programmes for advanced cancer patients will be useful when implementing such programmes.
The goal of palliative care is not to ensure that patients die at home, but to facilitate that they die at their preferred place of death. Nevertheless, there is a significant difference between the number of people who prefer to be cared for and eventually die at home, and the current number of people that actually die at home. Our study has shown, as other have as well, that involving multidisciplinary palliative home care teams and palliative care reference persons in care homes could support people when dying outside the hospital setting. Health care policymakers should consider strategies to improve involvement of palliative care services in all healthcare settings. Home was the preferred place of death for most cancer patients; thus effective programmes to enable patients to remain at home should be implemented.
1. Alonso-Babarro, Alberto, Astray-Mochales, Jenaro; Domínguez-Berjón, Felicitas; Gènova-Maleras, Ricard; Bruera, Eduardo; Díaz-Mayordomo, Antonio; Centeno, Carlos. ‘The Association between Inpatient Death, Utilization of Hospital Resources and Availability of Palliative Home Care for Cancer Patients’. Palliative Medicine, January 2013, 27(1): 68-75, first published on 4 April 2012, doi:10.1177/0269216312442973. (To download a copy of this paper, please see below).
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