Services given and help perceived during home care for terminal cancer

Separate accounts of care were recorded weekly from staff, patients and relatives in a randomised sample of patients with terminal cancer referred to a home care service with readily available beds. Various services were involved but nurses made most contacts, 3.0 visits and 2.4 phone calls weekly, rising sharply in the last week. General practitioners averaged 0.4 visits/week but their considerable variation evoked either praise or criticism. Maintaining contact, giving explanations and support were reported to help as often as physical treatments and practical nursing, although staff's and recipients' accounts differed slightly. Help succeeded for many problems, but weakness was common, often grew worse and led to more admissions than pain. Difficulties in relieving fatigue and strain in relatives also curtailed home care. Subsequent home care team reorganisation to strengthen linkage between particular nurses and patients and the improvement of day care services were associated with successive but modest rises from the original 27% to 34% of patients dying at home. Implications of the results for services and skills required for home care are discussed, noting the problems that deserve further attention.