Assessment of Patient Satisfaction in Palliative Cancer When They Return Home After Hospitalization in Palliative Care

• Background and rationale of the research project Palliative care is defined, according to the French Society for Support and Palliative Care as acute care delivered in a comprehensive approach to the person with a serious illness, progressive or terminal. Their goal is to relieve physical pain and other symptoms, but also take into account the psychological, social and spiritual suffering. According to this definition, palliative care is interdisciplinary, cater to the patient as a person and his family, at home or in an institution and strive to preserve the best possible quality of life until death.

Very few studies on the quality of life for patients at end of life were conducted in France. Among them, the TRAPADO study is a prospective study to evaluate the quality of care, quality of life and impact on the environment in three parallel cohorts of cancer patients in palliative phase according to their choice of inpatient traditional in palliative care or home. The interim analysis of this study, was published in 2006 in the journal Bulletin of cancer: patients expressed a priority choice for the home; there was a marked alteration of the overall quality of life, as measured by the EORTC-QLQC30, no statistically significant difference between home and hospital; anxiety level was higher in the hospital. Relatives were satisfied with the care of the patient with a good perception of the family fabric and expressed a lower level of psychosocial distress at home. Nevertheless, the terminal readmissions were common with a large majority of hospital deaths.

More recently, Régis Aubry, in the framework of the National Observatory on End of Life (ONFV), has conducted an extensive field survey, published in March 2013, up to the caregivers who meet together near home but also health professionals involved in supporting patients at end of life. The report of this work highlights the importance of developing palliative care in the home including the intervention of specialized teams and coordination of teams working at home.

Indeed, in France, while 81% of the French would "spend their last moments at home" (FIFG, 2010), only 25.5% of deaths occur at home (ONFV, 2012).

Faced with this reality, we were asked to know what elements can explain this discrepancy between this reality and the desire of patients. This issue was the subject of a preliminary study, conducted in 2013 in Lower Normandy region. We chose to study the management of patients with cancer in palliative home situation by their GP after hospitalization Identified beds Palliative Care (LISP) Centre François Baclesse Caen: 19 of the 23 patients assessed, have expressed their willingness on the place of death to their GP, wanted to die at home. Nearly half (48%) of patients in our study died in the hospital. GPs interviewed reported that maintaining the homes of these patients had been facilitated by the relief of distressing symptoms and the establishment of aid.