Assessing quality of end-of-life hospital care in a southern European regional health service.
OBJECTIVE
During the final period of life, patients with cancer in the Basque Country are given treatment in different types of hospital care. This study compared the quality of care according to the type of care in one of the autonomous communities in Spain.


METHODS
A retrospective study was carried out of cancer patients who died in conventional hospital services, home hospitalization services, and palliative care units. In addition to hospital stay and readmission number, variables based on the recommendations of Spanish Society for Palliative Care were studied.


RESULTS
End-of-life was diagnosed in 57 percent of a sample of 486 patients, 3 days before death (median). The use of symptom control scales was only documented in the clinical records of eight patients. Sociofamily evaluation was not found. Patients in conventional hospital services were less frequently diagnosed with end-of-life and agony and were significantly different from the rest in the reasons for admission, symptoms assessed, drugs used, administration routes, and dosage forms. Pain was evaluated in 50 percent of the patients and was better controlled in palliative care units. Patients not diagnosed with agony (52 percent) were more frequently not given specific treatment.


CONCLUSIONS
End-of-life in cancer patients was diagnosed too late. The quality of care in palliative care units and by home hospitalization service was better than that in conventional hospitalization. Nevertheless, there were areas for improvement in the three modalities of care.
Aldasoro
Elena
E
Service of Studies and Research, Department of Health of the Basque Government, 1 Donostia-San Sebastián, Vitoria-Gasteiz, Spain 01010. ealdasoro-san@ej-gv.es
Alonso
Adelina Pérez
AP
Ribacoba
Laureano
L
Esnaola
Santiago
S
Olaizola
Maite
M
Carrera
Jose Antonio
JA
Bañuelos
Ana
A
Rico
Rosa
R
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D018575:Home Care Services, Hospital-Based; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D009369:Neoplasms; D010166:Palliative Care / Q000379:methods*; D011787:Quality of Health Care; D012189:Retrospective Studies; D013030:Spain; D019452:Terminally Ill