[Ambulatory palliative care--special qualities]

During the last phase of progressive cancer numerous problems may arise. Additionally to pain and other symptoms, psycho-social and spiritual considerations supervene. In such cases palliative medicine offers positive options. In Germany, these options have been made available mainly for in-patients (at palliative care units or hospices). But out-patient care must continue to be a priority, since most patients wish to remain at home as long as possible and die at home. There are various problems that also arise at a patient's home. As the possibilities of palliative medicine are still generally unknown in out-patient care, new structures of medical care have to be established. This is where home care services come in; staff, especially educated professionals supported by volunteers assist the patients at home, together with general practitioners and health and advice centres. The work of home care services focuses on supervising pain therapy and symptom control as well as psychosocial advice and support of patients and their families. The statistics of the home care service Bonn shows that in 1999 73 per cent of patients could be treated at home until the end of live. In 43 per cent physicians made the initial contact with this service organisation. This proves the necessity and acceptance of new structures in palliative out-patient care.