1. Places for care:
   • Institutional:
     • Hospital.
     • Rehabilitation unit.
     • Long-term acute care.
     • Skilled nursing facility.
     • Inpatient hospice unit.[1,2]
   
   
   
   • Residential:
     • Home.
     • Assisted-living facility.
     • Nursing home.[3]
   
   
   



2. Possible team members for delivery of care:
   • Nurse, advance practice nurse (nurse practitioner, clinical nurse specialist, oncology, hospice, home care, rehabilitative, palliative care, radiation therapy).
   
   
   
   • Physician (oncologist, hospice, palliative care, primary care provider, general practitioner, internist, physiatrist [physician who specializes in physical medicine and rehabilitation]).
   
   
   
   • Dietitian.
   
   
   
   • Physical therapist.
   
   
   
   • Occupational therapist.
   
   
   
   • Medical social worker: assessment and referral for concrete services.[4]
   
   
   
   • Mental health professional: psychiatric nurse, psychiatric social worker, psychologist, and psychiatrist.
   
   
   
   • Family minister, chaplain, priest, rabbi, or other clergy.
   
   
   
   • Companion.
   
   
   
   • Nursing assistants (may possibly be obtained through sectarian or nonsectarian family agencies for a minimal fee or free of charge, or may be obtained through proprietary home care agencies at patient and/or family expense).
   
   
   



3. Programs offering a range of skills for delivery of care:
   • Home health agencies.
   • Hospice programs.
   • Palliative care (consultation) programs.
   • Community psychosocial support programs.
   • Home infusion agencies.
   • Bereavement programs.[5]



4. Legal and/or advanced directives:
   • Physician.
   • Hospital social worker.
   • Family attorney.
   • Legal Aid Society.
   • Law school clinics.
   • Maintenance of written documentation regarding patient’s wishes.



5. Pharmaceutical support:
   • Pain and symptom management (e.g., opioids, anxiolytics, antidepressants, antiemetics, and appetite stimulants).[2,6-8] (Refer to the PDQ summary on Pain for more information.)
   
   
   
   • Chemotherapy.
   
   
   
   • Transfusions (blood products).
   
   
   
   • Antibiotics.
   
   
   
   • Growth factors.
   
   
   
   • Nutrition (enteral and total parenteral). (Refer to the PDQ summary on Nutrition in Cancer Care for more information.)
   
   
   
   • Respiratory therapy.
   
   
   
   • Wound and skin preparations.
   
   
   



6. Nutrition:
   • Standard oral.
   
   
   
   • Supplemental:
     • Oral.
     • Enteral nutrition by nasogastric feeding, gastrointestinal, gastrojejunostomy, or percutaneous endoscopic gastrostomy tubes.
     • Parenteral nutrition (PN), central or peripheral.[9]
   
   
   
   • None (as an option).
   
   
   
   • Evaluation of nutritional status and home education.
   
   
   

   (Refer to the PDQ summary on Nutrition in Cancer Care for more information.)




7. Special devices:
   • Ostomies/drainage devices:
     • Gastrostomy.
     • Colostomy.
     • Ileostomy.
     • Tracheostomy.
     • Pleural fluid drains (e.g., chest tube and Denver catheter).
     • Biliary drainage tube.
     • Abscess drainage devices.
     • Percutaneous nephrostomy tube.
     • Paracentesis draining devices.
   
   
   
   • Assistive devices:
     • Hospital bed.
     • Commode chair.
     • Wheelchair.
     • Wheelchair cushions.
     • Scooter.
     • Walker.
     • Cane.
     • Crutches.
     • Braces.
     • Prostheses.
     • Handheld shower.
     • Shower/tub chair.
     • Orthoses.
     • Specialized mattress or overlay.
     • Overbed trapeze.
     • Mechanical lifts.
   
   
   
   • Catheters:
     • Central venous access catheter.
     • Peripheral catheter (e.g., peripherally inserted central catheter).
     • Dialysis catheter.
     • Urinary catheter: condom catheter, indwelling catheter (Foley or suprapubic).
     • Epidural or intrathecal catheter.
   
   
   
   • Venous pumps (permanent or temporary):
     • Chemotherapy.
     • Opioids (subcutaneous infusions for opioids).
     • Pain medication. (Refer to the PDQ summary on Pain for more information.)
   
   
   
   • Suction equipment:
     • Nasogastric and endotracheal suctioning devices.
     • Yankur suction tube.
   
   
   
   • Respiratory:
     • Oxygen (portable, stationary).
     • Assisted ventilation (portable respirator, continuous positive airway pressure, bi-level positive airway pressure, Vapotherm humidification system).
     • Respiratory treatments (chest physiotherapy, intermittent positive pressure breathing inhalers, or nebulizer treatments).
   
   
   

References

1. Plumb JD, Ogle KS: Hospice care. Prim Care 19 (4): 807-20, 1992.  [PUBMED Abstract]
   
   
2. Ramsay A: Care of cancer patients in a home-based hospice program: a comparison of oncologists and primary care physicians. J Fam Pract 34 (2): 170-4, 1992.  [PUBMED Abstract]
   
   
3. Jordhøy MS, Saltvedt I, Fayers P, et al.: Which cancer patients die in nursing homes? Quality of life, medical and sociodemographic characteristics. Palliat Med 17 (5): 433-44, 2003.  [PUBMED Abstract]
   
   
4. Jones RV, Hansford J, Fiske J: Death from cancer at home: the carers' perspective. BMJ 306 (6872): 249-51, 1993.  [PUBMED Abstract]
   
   
5. Whittam EH: Terminal care of the dying child. Psychosocial implications of care. Cancer 71 (10 Suppl): 3450-62, 1993.  [PUBMED Abstract]
   
   
6. Wotring RA: Cancer pain management. Home Healthc Nurse 11 (5): 40-4, 1993 Sep-Oct.  [PUBMED Abstract]
   
   
7. Herbst LH, Strause LG: Transdermal fentanyl use in hospice home-care patients with chronic cancer pain. J Pain Symptom Manage 7 (3 Suppl): S54-7, 1992.  [PUBMED Abstract]
   
   
8. McCormack A, Hunter-Smith D, Piotrowski ZH, et al.: Analgesic use in home hospice cancer patients. J Fam Pract 34 (2): 160-4, 1992.  [PUBMED Abstract]
   
   
9. Howard L: Home parenteral and enteral nutrition in cancer patients. Cancer 72 (11 Suppl): 3531-41, 1993.  [PUBMED Abstract]
   
   

Back to Top

< Previous Section  |  Next Section >