A Shared Care Approach for Seriously Ill Cancer Patients Between General Practice, Discharge Department and a Specialist Palliative Care Team

Background: Approximately one third of all deaths in Denmark are caused by cancer. Both Danish and international research shows that the majority of terminally ill cancer patients wish to die at home. In Denmark only about 25% has this wish fulfilled. The General Practitioner (GP) has traditionally had the full responsibility for the palliative care of terminally ill cancer patients. In recent years changes have been made to the organisation of palliative care: some hospitals have set up specialised palliative care teams and in some areas of Denmark hospices have been established. Recent research defines a problem when it comes to communication between the hospital and general practice when the patient is being discharged. This is often done in a way that can cause the patient to feel "left in limbo", especially if it is not completely clear to the patient and his or her relatives who has the responsibility for the palliative care. Objective: 1. To describe consequences for patients, relatives and health care professionals of three different ways of organising palliative care 2. To collect data which describes patients who are candidates to a shared care approach between general practice and a specialised palliative care team 3. To collect data which describes the palliative phase (place of death and palliative care, admissions to hospital, involvement of GP and district nurse etc.) 4. To describe terminally ill cancer patients and their relatives expectations of the health care system 270 terminally ill cancer patients will be invited to take part in the study. Data will be collected by interview with patients and questionnaires for patients, relatives and involved health care professionals.

Sex

All

Minimum age

18 Years

Inclusion Criteria:

In order to be included the patients have to be diagnosed as suffering from terminal cancer. The patients should also:

1. Be 18 years or older
2. Be able to speak and write Danish fluently
3. Give written and spoken consent
4. Be able to manage in their own home, with or without the help of carers and district nurses
5. Be informed about the diagnosis, also that it is incurable
6. Be registered as suffering from a terminal illness or fulfil the criteria for this -

Exclusion Criteria:

Patients are excluded if they:

1. Have a low level of cognitive skills, which makes it difficult for them to fill in a questionnaire
2. Are residents of a nursing home at the time of inclusion
3. Are receiving oncologic treatment which requires attending an out-patients clinic regularly
4. Already have established contact with a specialist palliative care team at the time of inclusion -