RESUMEN
Many patients in Switzerland wish to die at home. Nevertheless, end-of-life home care requests specific considerations such as basic palliative care knowledge among health care professionals and a well-organized and coordinated health care network which needs to be put in place as early as possible. Beforehand, an open discussion with the patient and the caregiver about their expectations and wishes is mandatory. Furthermore, anticipation about the evolution of the disease, potential symptoms, material requests, psychological and social barriers is the key element to provide home palliative care until the end of life. Most "cantons from the Romandie" have a large offer in health care services allowing for home end-of-life care.
Une fin de vie à domicile est souhaitée par beaucoup de patients en Suisse, mais sa mise en place nécessite entre autres des connaissances en matière de soins palliatifs et l'organisation précoce d'un réseau de soins interprofessionnel bien organisé et coordonné. Un prérequis est également une discussion ouverte avec le patient et son entourage quant aux attentes et souhaits de soins. L'anticipation par rapport à différents sujets tels que l'évolution de la maladie, les symptômes potentiels, les besoins en matériel, les difficultés psychiques et les problématiques sociales est l'élément clé pour une réussite d'une fin de vie à domicile. Plusieurs cantons romands offrent une large gamme de soins permettant un maintien au domicile jusqu'au décès.
Asunto(s)
Servicios de Atención de Salud a Domicilio , Cuidado Terminal , Humanos , Cuidados Paliativos , Muerte , Cuidadores/psicologíaRESUMEN
BACKGROUND: The early introduction of palliative care can have a positive impact on the quality of life of patients suffering from life-limiting diseases. However, the palliative care needs of older, frail, housebound patients are still mostly unknown, as is the impact of frailty on the importance of these needs. OBJECTIVES: To identify the palliative care needs of frail, older, housebound patients in the community. METHODS: We conducted a cross-sectional observational study. This study took place in a single primary care center and included patients who were ≥65 years old, housebound, followed by the Geriatric Community Unit of the Geneva University Hospitals. RESULTS: Seventy-one patients completed the study. Most patients were female (56.9%), and mean age (SD) was 81.1 (±7.9). The Edmonton Symptom Assessment Scale mean (SD) score was higher in frail patients as opposed to vulnerable patients for tiredness (p = 0.016), drowsiness (p = 0.0196), loss of appetite (p = 0.0124), and impaired feeling of well-being (p = 0.0132). There was no difference in spiritual well-being, measured by the spiritual scale subgroup of the Functional Assessment of the Chronic Illness Therapy-Spiritual Well-Being scale (FACIT-sp) between frail and vulnerable participants, although scores in both groups were low. Caregivers were mainly spouses (45%) and daughters (27.5%) with a mean (SD) age of 70.7 (±13.6). The overall carer-burden measured by the Mini-Zarit was low. SIGNIFICANCE OF RESULTS: Older, frail, housebound patients have specific needs that differ from non-frail patients and should guide future palliative care provision. How and when palliative care should be provided to this population remains to be determined.