Experience of End-of-Life Home Care in an Acute General Community Hospital in Japan

Abstract

We sometimes encounter situations in which it is impossible to find appropriate home care clinics despite patients wish of spending end of life (EOL) at home. We herein report our experience in cases of EOL home-based care managed by medical staff in an acute general community hospital. We retrospectively reviewed the clinical data of five cancer patients who received EOL home care managed by our institution between May 2016 and October 2018. We assessed the background characteristics and clinical course, how medical staff managed the patients and degree of satisfaction in the EOL care we provided, based on impressions interviews with the patients and their families. The median duration between the final examination by doctors in the hospital and death was 5 days (range: 7 h - 5 days). Regarding the visits to the four patients other than the one who died during her outing, home-visit nurses visited the patients homes every day in three of four patients, and both a care manager and a medical social worker (MSW) tried to evaluate the condition of the remaining patient by visits and phone calls. Information on the patients condition at home was given to the medical staff in order to discuss optimal home care. When they died, a doctor, a home-visit nurse, a nurse belonging to the palliative care team and a MSW visited in all cases. All patients spent their EOL calmly at home, and their families were pleased with their EOL and grateful to the medical staff who supported the patients. We supported patients EOL by managing home-based medical care in cooperation with multi-occupational staff. We should organize a system for meeting patients changing wishes flexibly.




J Med Cases. 2019;10(3):75-77
doi: https://doi.org/10.14740/jmc3263