title: Impact of specialist home-based palliative care services in a tertiary oncology set up: a prospective non-randomized observational study.
abstract: BACKGROUND
  Home-based specialist palliative care services are developed to meet the needs of the patients in advanced stage of cancer at home with physical symptoms and distress. Specialist home care services are intended to improve symptom control and quality of life, enable patients to stay at home, and avoid unnecessary hospital admission.
  
  
  METHODS
  Total 690 new cases registered under home-based palliative care service in the year 2012 were prospectively studied to assess the impact of specialist home-based services using Edmonton symptom assessment scale (ESAS) and other parameters.
  
  
  RESULTS
  Out of the 690 registered cases, 506 patients received home-based palliative care. 50.98% patients were cared for at home, 28.85% patients needed hospice referral and 20.15% patients needed brief period of hospitalization. All patients receiving specialist home care had good relief of physical symptoms (P < 0.005). 83.2% patients received out of hours care (OOH) through liaising with local general practitioners; 42.68% received home based bereavement care and 91.66% had good bereavement outcomes.
  
  
  CONCLUSIONS
  Specialist home-based palliative care improved symptom control, health-related communication and psychosocial support. It promoted increased number of home-based death, appropriate and early hospice referral, and averted needless hospitalization. It improved bereavement outcomes, and caregiver satisfaction.
authors.affiliation: Department of Palliative Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India.
authors.forename: Sunil R
authors.initials: SR
authors.lastname: Dhiliwal
authors.affiliation: Department of Palliative Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India.
authors.forename: Maryann
authors.initials: M
authors.lastname: Muckaden
keywords: Bereavement care; out of hours care; physical symptoms; specialist home-based palliative care