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Palliative care in a general teaching hospital. 1. Assessment of needs
1Palliative Care Service, Austin Hospital, Heidelberg, Vic.
Objective:
To assess the palliative care needs and the results of treatment of patients with terminal cancer admitted to a general teaching hospital.
Design, Setting, Patients:
A retrospective analysis of 110 consecutive patients with terminal cancer admitted to the Austin Hospital.
Main Outcome Measures:
The occurrence and relief of pain, the use of allied health services and the place of death.
Main Results:
Pain was the most common symptom and was satisfactorily improved in only two-thirds of the patients. Allied health services were used sporadically and appeared to be underused. Psychological problems were documented in very few patients. Only seven patients died at home, the remainder dying in hospital (82) or in a hospice (21).
Conclusions:
One-third of patients with terminal cancer in a general teaching hospital received inadequate pain relief; the reasons for this included lack of medical expertise in the use of analgesics for chronic cancer pain and the frequent use of analgesia given only "as required". The underuse of allied health services, the infrequent documentation of psychological issues and the observation that only a small proportion of patients were able to die outside hospital all underline the need for a coordinated multidisciplinary approach to the management of patients with terminal cancer.