Danish Medical Bulletin - No. 3. August 2009. Vol. 56 Page 171

ABSTRACT OF DISSERTATION

Palliative home care for
cancer patients in Denmark
- with a particular focus on
the present and future role of general practice

Mette Asbjørn Neergaard, MD

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This PhD dissertation was accepted by the Faculty of Health Sciences of the University of Aarhus, and defended on May 29, 2009.

Official opponents: Marianne Ewertz, Mogens Grønvold, and Bo Christensen.

Supervisors: Frede Olesen, Jens Søndergaard, and Anders Bonde Jensen.

Correspondence: Mette Asbjørn Neergaard, Åbyvej 48, 8230 Åbyhøj, Denmark.

E-mail: man@alm.au.dk

ABSTRACT

The study emanated from The Research Unit and Department for General Practice of the University of Aarhus, and was conducted from 2005 to 2008 in the former Aarhus County, Denmark. The thesis is based on five papers and focuses on palliative home care for cancer patients.

The overall aims of the study were to obtain knowledge about bereaved relatives' and professionals' suggestions for improvements and expectations of the function and organisation of palliative home care, and to find factors associated with the experience of a successful palliative care pathway.

The study was a mixed method study including focus group interviews and a combined register and questionnaire study of consecutive cases of 599 deceased cancer patients.

Interviews revealed that palliative care was insufficient, mainly due to organizational and cultural problems among professionals. Particular attention should be drawn to the need of support of the relatives both throughout the palliative pathway and in bereavement (Papers 1 and 2).

The survey showed that active involvement of general practitioners making home visits was independently associated with a higher likelihood of home death (Paper 3) and that dying at home was positively associated with a higher likelihood that the bereaved relatives would evaluate the palliative care pathway as successful, but no associations between "a successful pathway" and the efforts of the general practitioners and community nurses were found (Paper 4 and 5).

Development and improvement of the basic level palliative care efforts in the patients' homes is needed. To achieve more successful palliative pathways, it would be of particular importance to further explore the role of the relatives, the co-operation of professionals - in terms of organisation and working culture - and the services and involvement of primary care professionals. Finally, education of both primary and secondary health care professionals should be improved and further research in the organisation of the palliative care efforts should be encouraged.
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