Galilee Palliative Care Unit, Spata
“Out of Hours” Telephone Support Service in a Greek Home Palliative Care Unit
Out-of-hours (OOH) telephone support to cancer patients and their caregivers is an essential element of quality service. “GALILEE” is the first Palliative Care Unit in Greece, providing interdisciplinary palliative care services to adult cancer patients on the outskirts of Athens, since March 2010.
To develop and operate a standardized “Out of Hours“ nurse-led, telephone support service and to evaluate patient/family satisfaction and staff burden.
Prospective epidemiological data of callers, characteristics of calls, requests, and interventions were recorded from an OOH service for 8 months. Family satisfaction was assessed 6-12 months after service provision by the FAMCARE questionnaire and staff burden was discussed in a focus group.
1. Patients’ and carers’ needs and staff interventions Analysis
Fifty six out of 98 (57.1%) patients cared for during the study period used the OOH service (334 calls). There were 322 “needs” reported, mostly by patients’ children (32.0%) and only 11.8% by the patients’ themselves. Most callers (89.4%) made one call (max 6), of 4.3 min mean duration (max 22min), usually in the afternoons on weekdays (45.5%). Symptom/Problem (54.7%), mostly pain (21.3%) and end of life issues (13.6%) were more prevalent among the different “needs” followed by information exchange/updating (18.9%) and medications (15.2%). Nurses characterized 52.8% of requests as “emergencies”, more often those in the Symptom/Problem category (68.2%) and among them physical symptoms and end of life issues (x2(4)=44.1, p< 0.001). Advising and supporting callers was the most frequent (41.6%) initial intervention, along with pharmacological interventions in 38.1%, or practical issues (13.1%). Nurses were able to effectively address 69.3% of requests by phone, while a physician’s advice was needed in 22.7%. Hospital admission was advised in 2.5%, and there were also 3 home visits (0.9%).
2. Family Satisfaction Evaluation
The questionnaires were introduced in person to 56 carers and 37 (66.1%) agreed to take part. Most carers were female (78.4%) , with mean age 61.0±12.8 (31-84) years. Most patients, were male (59.5%), mean age 70.4±11.1 (46-91) years, suffering mostly from lung (27%), or breast (16.2%) cancer and died (78.4%) mostly at home (55.2%). Overall, satisfaction from the OOH telephone support line was very high and strongly correlated to the staff availability, informational needs fulfillment, physical and psychosocial care. There was no correlation of family satisfaction with most parameters, such as carer’s age, sex, family status, educational background, age and sex of the patient, place of death, etc. A positive correlation was found between the carer’s age, spirituality of the carer and the type of the patient’s cancer, for instance those with lung cancer were more satisfied (z=-3.32, p=0.001, Bonferroni p<0.007.) (5.0±0.0) than those with colon cancer (4.0±0.0).
3. Staff burden evaluation
The focus group analysis revealed that nurses considered the 24/7 telephone support vital to the quality of care and determinant of the patients’ place of death. It also increased nurses’ autonomy and satisfaction. Moreover, negative aspects were interference of the on-call service in their personal life, inability at times to respond to multiple calls from carers during the patient’s dying phase, without a home visit, difficulties in communicating with doctors when needed instantly and burden by electronic data recording during OOH.
In our experience, the OOH on-call service can, most of the time, be efficiently run by nurses as first line responders and can address patients’ and caregivers’ needs during OOH effectively, without a home visit, or inappropriate hospital admission.