OBJECTIVES: Brain tumours cause considerable concern due to a high mortality and there are increasing efforts to provide adequate care, sometimes outside hospitals. Health care utilisation, direct costs of care, and the indirect social cost of morbidity and early mortality caused by brain tumours in Sweden in the year 1996 was analysed. METHODS: Quantification of ambulatory care, care in hospital, long term and palliative/terminal care, drug consumption, temporary as well as long term morbidity, and mortality from comprehensive national data sources. Direct costs were calculated using 1996 charges. Indirect costs were calculated by sex and age specific salaries. A sensitivity analysis considered the impact of alternative estimates of each item. RESULTS: Indirect costs were 75% of the total and were caused mainly by early mortality. Direct costs were predominantly for care in hospital, long term care, and home health care. Among direct costs, astrocytomas III-IV and meningiomas accounted for 42% and 30% respectively. CONCLUSIONS: The cost of illness from brain tumours reflects the characteristics of these malignancies. Despite their low incidence rate, the economic impact caused by high mortality among young persons is a predominant trait. Costs of acute hospital care and also long term care and home care are considerable.
The goal of the study was to compare working conditions in a hospital with the conditions in a specialized hospital-based home care (HBHC) unit, which aims to replace hospital care for patients in need of institutional car. Staff (doctors included) in a HBHC unit (n = 35) and on three hospital wards (n = 113) participated in the study. All staff members worked regularly with severely ill cancer patients. Question about stress, job satisfaction and working conditions were asked in a self-administered questionnaire. Both groups showed a limited degree of continuous stress and a high degree of job satisfaction. Thus, the overall perception was than the working conditions were good. When significant differences were found, the responses of the HBHC staff were more positive. This included items such as more freedom to make their own decisions (P
A study was undertaken to measure the costs of caring for 20 terminally ill/dying cancer patients at home, within a hospital-based home-care system. A new method was used, by which all staff expenses were registered and the work costs per minute were calculated for each personnel category (e.g. nurses, physicians). The total number of care days amounted to 857. The average daily cost was 509 Skr. (range 87-2999), but it was higher for patients with the shortest periods of home-care ( = the dying patients). Comparisons were made between the costs of hospital-based home-care and those of hospital care in 1) a geriatric unit, 2) other somatic departments, and 3) those departments from which the patients had been referred. The costs of hospital-based home-care were 40%, 55%, and 67% lower than the three different forms of hospital care, respectively. All the patients had relatives at home and were intensely dependent on their families. The important part played by the relatives contributed to the relatively low costs. The ethical aspects of caring for dying cancer patients at home are discussed.
Evaluate the effectiveness of a continuing educational intervention on primary health care professionals' familiarity with information important to nutritional care in a palliative phase, their collaboration with other caregivers, and their level of knowledge about important aspects of nutritional care.
Observational cohort study.
10 primary health care centers in Stockholm County, Sweden.
140 district nurses/registered nurses and general practitioners/physicians working with home care.
87 professionals participated in the intervention group (IG) and 53 in the control group (CG). The intervention consisted of a web-based program offering factual knowledge; a practical exercise linking existing and new knowledge, abilities, and skills; and a case seminar facilitating reflection.
The intervention's effects were measured by a computer-based study-specific questionnaire before and after the intervention, which took approximately 1 month. The CG completed the questionnaire twice (1 month between response occasions). The intervention effects, odds ratios, were estimated by an ordinal logistic regression.
In the intra-group analyses, statistically significant changes occurred in the IG's responses to 28 of 32 items and the CG's responses to 4 of 32 items. In the inter-group analyses, statistically significant effects occurred in 20 of 32 statements: all 14 statements that assessed familiarity with important concepts and all 4 statements about collaboration with other caregivers but only 2 of the 14 statements concerning level of knowledge. The intervention effect varied between 2.5 and 12.0.
The intervention was effective in increasing familiarity with information important to nutritional care in a palliative phase and collaboration with other caregivers, both of which may create prerequisites for better nutritional care. However, the intervention needs to be revised to better increase the professionals' level of knowledge about important aspects of nutritional care.
It has been claimed that fentanyl patches are less suitable for elderly patients and for patients who are terminally ill and dying. In a retrospective survey of 205 cancer patients who died within the hospital-based home care in Norrköping, Sweden between January 1997 and June 1998 we identified 34 patients who had used fentanyl patches. 30 patients were possible to evaluate for the analgesic efficacy of transdermal fentanyl. 18 out of 30 patients were treated with fentanyl until time of death. The estimated efficacy was good or moderate in 93% and 88%, respectively, of patients younger or older than 65 years of age.
In many reports the percentage of home deaths in cancer is based on selected populations. In this population-based study all cancer patients who died within 12 months within a specified area were studied (n = 108). This area is covered by hospital-based home care (HBHC) on a 24-h basis, which doctors available by day and at night. Forty people (37%) out of the total cancer population died in their own homes. Another 11% would theoretically have been ideal candidates for home care at the end of life. Thus, a home death rate of about 50% of the cancer patients is a realistic figure, and much higher than the usual 5-15% reported, provided that an effective HBHC is offered.
In 1977, the first palliative home care programme in Sweden, the Motala hospital-based home care, was established to provide a high level of medical care on a 24-hour basis, as an alternative and a replacement to hospital care. The current study summarizes the care and organizational needs of 179 consecutive terminally ill cancer patients treated during a 10-year period. Of the patients, 70% came from acute clinics. The median time of care was 36 days. The need for help with activities of daily living was a significant predictor of the length of survival, with the greatest difference between four or less compared to five or six items (p = 0.0006). Analgesics were needed by 96% of the patients, and 78% were provided with various facilities such as hospital beds. The input of family members as primary caregivers was essential for successful care, as were security factors such as easy availability of a nurse or doctor, at any time day or night, and an immediate, guaranteed hospital bed, if needed. As many as 89% of the patients who wished to live at home until death actually did so. We conclude that hospital-based home care according to the Motala model can replace hospital care for selected patients, but only if both the patient and the family approve.