The missing part in the current practice of medicine: home care in palliative oncologic patients

Home care is a basic need for cancer patients in the palliative care service of the Instituto Nacional de Cancerologia (INCan) who requested to spend his last days of life in a comfortable and with autonomy. Was implemented palliative home care patient in the third level in conjunction with the primary care level to track, domiciliary care and home Death certiicate? Home care was scheduled for cancer patients with end-stage Palliative Prognostic Index (PPI) higher to one month, seen at least once at the INCan in the palliative care service and submits problems to attend the institution for poor functional status and symptoms are dificult to control. One or two palliative care teams performed one or two visits based on the status of each patient, was scheduled weekly or biweekly and follow up to death was by telephone. We include 233 Home visits; the socioeconomic level in most cases was low, with an average monthly income of $ 2,000.00 per family. The characteristics of the homes were modest. The average Karnofsky was 40%, with a survival of 61 days. The group was the lower survival of gastrointestinal tumors (19.3 days). At the initial visit were monitored an average of 8 symptoms (pain 94%, anorexia 97%, asthenia 99% and fatigue 81%), and in the last week of life the number of symptoms was greater. The number of visits was 3, with duration of 50 minutes (range 20-120 minutes). Most visits were in Tlalpan and Iztapalapa. 95% of the patients died at home, monitoring and the death certiicate was produced by the irst-level medical care. The 71% of family attended the bereavement workshop rated the service as excellent.