Abstract
Context
Empirical information on circumstances of dying from advanced illness in developing
countries remains sparse. Evidence indicates that out-of-hospital end-of-life care
can have significant benefits such as increased satisfaction for the patient and caregivers
and cost-effective for a health-care system. Services that are aimed to deliver care
at private homes may be a good model for low- and middle-income countries or other
low-resourced settings.
Objectives
To examine specialized, generalist, and informal palliative care provision and to
describe the end-of-life care goals and treatments received.
Method
A mortality follow-back study with data obtained from general practitioners certifying
a random sample of death certificates of adult decedents who died between March and
August 2018. The questionnaire inquired about the characteristics of care and treatment
preceding death.
Results
Three hundred nine questionnaires were mailed, and the response rate was 31% (N = 96), of which 76% were nonsudden deaths. Of these cases, 27.4% received no palliative
care, 39.7% received it from a general practitioner, and 6.8% from a specialized palliative
care service. Comfort maximization (60.3%) was the main goal of care in the last week
of life, and analgesics (53.4%) were the predominant treatment for achieving this
goal. In addition, 60.3% received informal palliative care from a family member.
Conclusion
The largest part of end-of-life care at home in Trinidad and Tobago is provided by
family members, whereas professional caregivers feature less prominently. To ensure
quality in end-of-life care, better access to analgesics is needed, and adequate support
and education for family members as well as general practitioners are highly recommended.
Key Words
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Article info
Publication history
Published online: July 06, 2020
Accepted:
June 22,
2020
Footnotes
Nicholas Jennings and Stacey Chamely are nationals and residents of Trinidad and Tobago.
Identification
Copyright
© 2020 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
