[Problems and deficits in the transition from inpatient and outpatient care of cancer patients. A qualitative analysis].
BACKGROUND
Problems and deficits in the transition between hospital-based and outpatient care of cancer patients were evaluated. The project was initiated by the Public Health Department of the City of Aachen and was carried out with cooperation from all hospitals in the urban areas.


METHODS
From September 2002 to April 2003 a total of 145 cancer patients fulfilling the inclusion criteria from 4 regional hospitals were documented at 4 time points within a period of 6-8 weeks by questionnaires, telephone and personal interviews. Aspects of interest were disease type, symptom burden, well-being, the homecare situation and medical aids required.


RESULTS
Patients and their relatives reported on inadequate pain management, insufficient preparation of transition, problems in information flow, organisational problems, lack of attention and humaneness, deficiency of care, delay of diagnosis, inadequate access to services, insufficient prescription of drugs and adjuvants, financial problems and quarrels with the health insurance company on payment of aid devices. Coping strategies were mostly non-functional and not problem-orientated.


CONCLUSIONS
Special attention should be paid to psychosocial and interpersonal needs of patients. Volunteers may have an important role in the care of patients and relatives. The introduction of case managers might lead to an advancement of care. Sensitisation of physicians, nurses and other caregivers for deficits in transition of patients is needed and should be covered in palliative care education and training.
Stiel
S
S
Klinik für Palliativmedizin, Universitätsklinikum RWTH Aachen, Pauwelsstr. 30, 52074 Aachen. sstiel@ukaachen.de
Joppich
R
R
Korb
K
K
Hahnen
M
M
Elsner
F
F
Rossaint
R
R
Radbruch
L
L
D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D001293:Attitude to Death; D017028:Caregivers / Q000523:psychology; D003430:Cross-Sectional Studies; D005260:Female; D005858:Germany; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006302:Health Services Research; D006767:Hospitals, District; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000627:therapeutic use; D009369:Neoplasms / Q000523:psychology / Q000628:therapy*; D010146:Pain / Q000523:psychology; D059408:Pain Management; D010166:Palliative Care / Q000523:psychology; D010351:Patient Discharge; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D011340:Problem Solving; D012803:Sick Role; D014342:Truth Disclosure; D055815:Young Adult
D009294:Narcotics
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