Even in the UK, which has a well-developed and comprehensive national palliative care system, a study analyzing all cancer deaths between 19 showed that 48% died in a hospital and 16% in hospices, while 25% died at home. A similar pattern is seen in other European countries, as the place of death in Europe is most frequently hospital or nursing home. According to the National Board of Health, 55% of Danish cancer patients died in hospitals, 18% in nursing homes or in specialist palliative care institutions, while only 26% died at home in 2005. Further, a recent prospective Danish study indicated that the majority (71%) of cancer patients in palliative care preferred to die in their own home. Similar preferences were reported in a retrospective Danish survey, which indicated that the majority of cancer patients in the palliative care phase preferred to die in their own home (81%) however, the reported preference for dying at home decreased towards time of death (64%). showed that most people with different terminal diseases preferred to die at home and the majority of patients did not change preferences as their illnesses progressed. A recent systematic review by Gomes et al. However, in most western countries more than half of the patients with advanced cancer die in hospitals. Studies have shown that most patients with advanced cancer prefer to spend the last part of their life at home (50-90%). Thus, a substantial need for palliative cancer care is observed. Almost five thousand of the inhabitants of the Capital Region dies of cancer every year (0.25%). The Capital Region of Denmark had in 2013 1,735,521 inhabitants with one of the highest incidences (0.6%) and prevalence (4.3%) of cancer in the world as well as a high cancer mortality rate (6.8%). Trial registrationĬ Identifier: NCT01885637 The present study offers a model for achieving optimal delivery of palliative care in the patient’s preferred place of care and attempt to clarify challenges. Programs that facilitate transition from hospital treatment to SPC at home for patients with incurable cancer can be a powerful tool to improve patients’ quality of life and support family/caregivers during the disease trajectory. Inclusion criteria are incurable cancer with no or limited antineoplastic treatment options. Patients are randomly assigned either to: a) standard care plus SPC enriched with a standardized psychological intervention for patients and caregivers at home or b) standard care alone. The planned sample size is 340 in- and outpatients treated at the Department of Oncology at Copenhagen University Hospital. Methods/DesignĭOMUS is a controlled randomized clinical trial with a balanced parallel-group randomization (1:1). The SPC in this trial is enriched with a manualized psychological intervention. The Danish Palliative Care Trial (DOMUS) aims to investigate whether an accelerated transition process from oncological treatment to continuing SPC at home for patients with incurable cancer results in more patients reaching their preferred place of care and death. The focus of Specialized Palliative Care (SPC) is to improve care for patients with incurable diseases and their families, which includes the opportunity to make their own choice of place of care and ultimately place of death.
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