The use of home care in terminal cancer.

In order to identify factors associated with the use of home care services and satisfaction with those services, interviews were conducted with 72 percent of the surviving relatives and 92 percent of the physicians of a random sample of 133 patients from the Rochester, New York, area who had died of cancer and who had been diagnosed at least two weeks before death. These interviews included a self-administered attitude questionnaire from which ten attitude-scale scores were derived. Forty-one percent of the sample had used organized home care services, almost all under a home-hospice program. In comparison with nonusers, home care users tended to be younger, married, to have a longer terminal care period, and to spend more of it at home. Relatives of patients who had used home care services, in comparison with relatives of nonusers, were less satisfied with the availability of care and reported that the patient had experienced more pain. This study also highlights problems in communication, particularly between the physician and the patients and their families, and the effects of home care on the families, especially the primary care-giver. In order for home care and home death to be viable options for a larger number of terminal cancer patients, family members need to be assured of around-the-clock availability of care, adequate pain control, and respite care to provide temporary relief from the burden of home care.