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A palliative-care intervention and death at home: a cluster randomised trial

Jordhoy, M S; Fayers, P; Saltnes, T; Ahlner-Elmqvist, Marianne LU ; Jannert, Magnus LU and Kaasa, S (2000) In The Lancet 356(9233). p.888-893
Abstract
BACKGROUND: The Palliative Medicine Unit at University Hospital of Trondheim, Norway, started an intervention programme that aims to enable patients to spend more time at home and die there if they prefer. Close cooperation was needed with the community health-care professionals, who acted as the principal formal caregivers, and a multidisciplinary consultant team coordinated the care. We did a cluster randomised trial to assess the intervention's effectiveness compared with conventional care METHODS: Community health-care districts in and around Trondheim, Norway, were defined as the clusters to be randomised. We enrolled 434 patients (235 assigned intervention and 199 conventional care [controls]) in these districts who had incurable... (More)
BACKGROUND: The Palliative Medicine Unit at University Hospital of Trondheim, Norway, started an intervention programme that aims to enable patients to spend more time at home and die there if they prefer. Close cooperation was needed with the community health-care professionals, who acted as the principal formal caregivers, and a multidisciplinary consultant team coordinated the care. We did a cluster randomised trial to assess the intervention's effectiveness compared with conventional care METHODS: Community health-care districts in and around Trondheim, Norway, were defined as the clusters to be randomised. We enrolled 434 patients (235 assigned intervention and 199 conventional care [controls]) in these districts who had incurable malignant disease and an expected survival of 2-9 months. Main outcomes were place of death and time spent in institutions in the last month of life. FINDINGS: 395 patients died. Of these, more intervention patients than controls died at home (54 [25%] vs 26 [15%], p<0.05). The time spent at home was not significantly increased, although intervention patients spent a smaller proportion of time in nursing homes in the last month of life than did controls (7.2 vs 14.6%, p<0.05). Hospital use was similar in the two groups. INTERPRETATION: The palliative-care intervention enabled more patients to die at home. More resources for care in the home (palliative care training and staff) and an increased focus on use of nursing homes would be necessary, however, to increase time at home and reduce hospital admissions. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
The Lancet
volume
356
issue
9233
pages
888 - 893
publisher
Elsevier Limited
external identifiers
  • pmid:11036893
  • scopus:0034626084
ISSN
1474-547X
DOI
10.1016/S0140-6736(00)02678-7
language
English
LU publication?
yes
id
d512e243-200a-4cff-90e2-9b3caa54114e (old id 1116777)
date added to LUP
2008-07-02 10:39:09
date last changed
2017-08-13 03:39:18
@article{d512e243-200a-4cff-90e2-9b3caa54114e,
  abstract     = {BACKGROUND: The Palliative Medicine Unit at University Hospital of Trondheim, Norway, started an intervention programme that aims to enable patients to spend more time at home and die there if they prefer. Close cooperation was needed with the community health-care professionals, who acted as the principal formal caregivers, and a multidisciplinary consultant team coordinated the care. We did a cluster randomised trial to assess the intervention's effectiveness compared with conventional care METHODS: Community health-care districts in and around Trondheim, Norway, were defined as the clusters to be randomised. We enrolled 434 patients (235 assigned intervention and 199 conventional care [controls]) in these districts who had incurable malignant disease and an expected survival of 2-9 months. Main outcomes were place of death and time spent in institutions in the last month of life. FINDINGS: 395 patients died. Of these, more intervention patients than controls died at home (54 [25%] vs 26 [15%], p&lt;0.05). The time spent at home was not significantly increased, although intervention patients spent a smaller proportion of time in nursing homes in the last month of life than did controls (7.2 vs 14.6%, p&lt;0.05). Hospital use was similar in the two groups. INTERPRETATION: The palliative-care intervention enabled more patients to die at home. More resources for care in the home (palliative care training and staff) and an increased focus on use of nursing homes would be necessary, however, to increase time at home and reduce hospital admissions.},
  author       = {Jordhoy, M S and Fayers, P and Saltnes, T and Ahlner-Elmqvist, Marianne and Jannert, Magnus and Kaasa, S},
  issn         = {1474-547X},
  language     = {eng},
  number       = {9233},
  pages        = {888--893},
  publisher    = {Elsevier Limited},
  series       = {The Lancet},
  title        = {A palliative-care intervention and death at home: a cluster randomised trial},
  url          = {http://dx.doi.org/10.1016/S0140-6736(00)02678-7},
  volume       = {356},
  year         = {2000},
}