Palliative care at home with low resources by a hospice center, Dhaka, Bangladesh

Abstract

Background: According to Bangladesh Cancer Society the economic burden of new adult cancer patients is 250000/yr., and the total cancer burden is 10, 00000/yr. According to the oncologists and referral hospitals approximately 75% of the cancer patients attending for treatment are incurable and they get treatment in palliative setting. 30-40% of these patients are in the end days of life with a lot of suffering and their admission is refused by the hospitals as our hospitals are overloaded with patients with acute illness. Objectives: To evaluate the patterns of disease, terminal symptoms, duration of home care, place of death and economic benefit for the patient. Method: This is a retrospective study based on patient’s record. The records of a total 40 patients were reviewed. Data from 28 patients who needed palliative care at home were analyzed from March 2015 to February 2016. The place of the study is the patient’s home within Dhaka, Bangladesh. Data was collected from patient’s register book and bed head tickets. Result: All patienst live in the Dhaka area and a majority of patient’s are age over 60 years. 53% were female and 46% male. All patients were married except one child and all were Muslim. Among them, the majority of diseases were cancer 50%, neurological problem 25%, cardiovascular problem 7% and renal diseases were 17%. Before receiving home care, the majority of them received conservative treatment 50%, chemotherapy 32%, surgery 3% and no treatment 14%. From the beginning of the care 39% were suffering pain and breathlessness, hypotension 17% and cough 3%. Regarding referral to palliative home care – among them doctors were 35%, patient’s attendant 32% and general people in society 32%. The longest duration of palliative home care was 350 days. Among the total patients the place of death – home 46%, hospital 21% and alive 32%. The most beneficial part of palliative home care was to reduce the hospital readmission 80% and reduce the economic burden 60%. Conclusion: The evolution and growth of palliative care services and hospices should be by the combined effort of both the public and the private sectors for affordable service. Without community involvement, establishment of this sector is not possible.