REVIEW – October 2009

Home supportive care of cancer patients in Estonia has twelve-year experience


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According to the definition by the World Health Organization, “Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening  illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual”. Palliative care  can be provided in a variety of places: in the person’s home, in hospitals, in nursing homes, or in hospices; it can be provided by a specialist or by a family doctor. The Estonian Cancer Society launched home supportive care of cancer patients in 1997. It represents palliative care specialized for cancer patients provided at patients’ home. Since 2001, 15 palliative care teams have been working across Estonia; altogether 17 doctors and 25 nurses are providing palliative care. One team consists of nurses, doctors, and volunteers. This service is free of charge for the patient but referral is needed. The number of home visits has increased in recent years, for example, in  2008 physicians made 4191 home visits. As most of the patients (70%) die at home, doctors and nurses must be well prepared to face end-of- life problems. Therefore, continuous training courses for doctors and nurses are organized regularly. According to evaluation, patients and family members appreciate home supportive care of cancer patients highly.

In conclusion, palliative care involves not only symptom control; an important aspect is also partnership between the person who has cancer, his or her family and friends, and members of the health care team. A well working team is one of the cornerstones of effective palliative care.