Evaluation of demand for palliative care services among patients at nursing hospital

Aim of the study: to evaluate the demand for palliative care services among patients at nursing and supportive care hospitals, that serve Kaunas city. Methods. The study started with patients' data from year 2008, personal statistical card form No. 066/a-LK (n = 1689), which were fulfilled by physicians at patients' discharge and obtained from 3 nursing hospitals in Kaunas. The findings as coded according to ICD-10 and therapeutical profile were compared with indications defined in national legislation for palliative care. During February–March 2009 the anonymous survey including the relatives of the patients was conducted in the hospitals using questionnaires. Sample size was 151, response rate 70.2%. Dementia patients were analyzed separately. Statistical data analysis was performed using software „SPSS for Windows 13.0“. Results. In nursing hospitals the palliative care was needed by 14.6% of patients with ischemic heart disease, 10.0% – with malignant tumours, 0.1% – with G12 (spinal muscular atrophy and related syndromes), 0.6% – with G35–G37 (demyelinating diseases of the central nervous system), 0.2% – with G93 (anoxic brain damage), 0.8% – with K70–71 (chronic liver insufficience), 0.2% – with N19 (unspecified renal failure). The questionnaire revealed, that nursing term of 120 days as defined by state was insufficient for 70.2% of cases. Special medical care and nursing was necessary for 83.0% of patients. 56% of relatives stated that the disease is progressing and patient needs hospitalization, 47% pointed the risk of death, for 69% of dementia patients the disease was progressing. The demand for palliative care from perspective of patients' relatives was 77.5% at nursing hospital, 13.9% at home, 7.9% at common hospital, and 0.7% at day care. Conclusions. 1. During 2008 at Kaunas nursing hospitals 26.5% of patients needed palliative care; 5.4% of dementia patients needed palliative care regardless of indications that define no need for palliative care. 2. Among the relatives of patients, 81% consider the need continuation of nursing, 14% would be willing to cover all costs of care longer than 120 days, 47% – to cover partially. Two thirds of responders would be willing to pay half of nursing services costs. Average demanded continuation is 8 months. 3. Responders consider, that 56% of patients need palliative care, 85.4% need in-patient care; 53% consider the dementia to be the main disease and two thirds of dementia patients need palliative care