Aim

To identify the issues in End of life care with relation to Home care, Local Hospital care and also identifying the persons involved in decision making for patients along with the Physician.

Methods

Around 1400 new oncology  cases are being referred to Meenakshi Mission Hospital and Research centre, Madurai, with 75% of the patients coming from a rural background. During the period from June 2011 to February 2012, 68 patients/ caregivers who refused End of Life care at local place were asked to fill up a semi structured Questionnaire to assess the reasons and also identify the persons involved in decision making on the same.

Results

On analysing  52(76.5%) of them  had single factor and 16(23.5%) had more than one factor as the reason for refusal of home care. Out of the 68 respondents 30(44.1%) felt that there was no motivated person  at home, 22(32.4%) felt that the facilities at home are insufficient , 18(26.5%) felt inadequate  medical facilities available nearby and round the clock for service, 12(17.7%) of them were not willing to take care at home and 5(7.4%)of them refused due to family issues . For Hospital care 50(73.5%) refused due to local physician's unwillingness and 18(26.5%) didn't have a local hospital for care as they hail from a very small village. Decision of 43patients (63.2%)  was made by the spouse and their children. In 11(16.2%) it was village head and in 9(13.2%) it was friends and relatives as they were illiterate.

Conclusion

Hospice if developed  can cater the neighbouring rural areas. End of  life training for local physician and nurses will help patients take home and hospital care. This will help in reducing the burden in these families to a larger extent both physically, financially and mentally.