Sep 2, 2021
This episode features Dr Markus Krause (Institute of General
Practice and Family Medicine, Jena University Hospital, Jena,
Germany) and Dr Antje Freytag (Institute of General Practice and
Family Medicine, Jena University Hospital, Jena, Germany).
Palliative homecare is an important component of palliative care,
and it has a positive impact on the quality of care at the
end-of-life. The effect of different types of palliative homecare
on quality of care is sparsely researched. Within palliative
homecare, cancer patients still outweigh non-cancer patients.
We compared two types of palliative homecare in Germany: primary
palliative care and specialized palliative homecare. Both reduced
potentially aggressive interventions at the end-of-life. The
more comprehensive specialized palliative homecare was
associated with less potentially aggressive interventions in terms
of lower rates of hospital as the place of death, hospital care,
intensive care treatment, chemotherapy, and application of a
percutaneous endoscopic gastrostomy (PEG) within the last days of
life. These results hold equally for cancer patients as well as
non-cancer patients. Only for parenteral nutrition, we found a
possible indication of oversupply in cancer patients (excepting
those with gastrointestinal cancer) within specialized palliative
homecare.
The potential of palliative homecare, particularly of specialized
palliative homecare, to reduce potentially aggressive interventions
at the end-of-life deserves more attention in healthcare and health
politics. Future studies should investigate which elements of
specialized palliative homecare are effective and can be integrated
into primary palliative care, where appropriate.