[Current status and problems of home care for patients with terminal cancer from the viewpoint of local clinics].

On the basis of investigations of 15 patients from our clinic with terminal cancer who were treated by home hospice care, and questionnaires filled out by their caretakers, we examined the current status and problems of the home hospice care system with respect to four phases, namely, the period of preparation for home care (hospitalization period), stable period, terminal period, and the period immediately before death. [Preparation period] The following problems occurred in this phase: introduction of pain management and nutrition management was insufficient; there were only a few cases in which the patient chose home care of his or her own will; and sufficient instructions were not given to caretakers on discharge from the hospital, with respect to medical treatment at home. [Stable period] In two of the four cases in which patients complained of severe pain, the pain was not alleviated because pain management was provided only at the outpatient clinics of the hospital, and collaboration between hospitals and our clinic was insufficient. [Terminal period] Two patients could not be admitted to the hospital upon sudden exacerbation of the condition, suggesting the need to establish a system in which large hospitals can cope with sudden exacerbation of their condition of patients with terminal cancer treated at home. [Period immediately before death] Of the 14 patients who died, 7 died at home and 7 died in the hospital or during transport to the hospital. Three subjects died within a few days after admission. Two of the subjects who died in the hospital or during transport had hoped to stay home until the last moment. Further improvement of the system is necessary in order to meet the needs of terminal cancer patients who wish to die at home. On the basis of the cases taken care of at our clinic, we examined the home care system according classification into three types; hospital-outpatient clinic type; hospital-home care type; and clinic-home care type. An ideal system for the treatment of patients with terminal cancer who hope to stay at home until the last possible moment seems to be the clinic-home care type in which a primary care team that is able to dispatch physicians and nurses, and an around-the-clock support system, are supported by outside organizations and specialists.