[Quality of life in palliative care--a comparison of hospital and home care]

Abstract

The aim of palliative care for seriously ill and dying patients suffering from oncological diseases is to obtain or enhance the quality of their lifes. It will become more and more necessary to evaluate and record the efficiency of different kinds of medical care with reliable and validated instruments. Professional home care will gain in importance for various political and economic reasons. The central question asked of palliative care will be how outpatient and inpatient care affects quality of life and if differences can be detected between both kinds of care. A representative group of 121 patients was chosen from a group of 250 terminally ill cancer patients who were either in ambulant or inpatient palliative care (outpatients n = 57, inpatients n = 64). Within the first 24 hours after either admission into the palliative sector of a hospital or first contact with the ambulant "Palliative Home Care Team" at home the patient's quality of life was estimated. After one week another estimation followed. The questionnaire EORTC-QLQ-C30, developed by the European Organisation for Research and Treatment of Cancer and translated into German, was used for this. Both groups of patients were homogeneous in their demographic parameters. In both groups improvements in nearly every dimension of quality of life were achieved between the first and the second assessment. The dimensions of symptom control (pain, fatigue, vomiting, and breathlessness) improved most distinctively in the outpatient care group. The German EORTC-QLQ-C30 turned out to be a reliable evaluation instrument for measuring patients' quality of life in out-patient or inpatient palliative care. Ambulant care always has to be considered as an alternative to inpatient care without leading to any quality deficits.