How medical services mask provision of non-medical supportive care in palliative oncology ?

Abstract

OBJECTIVES In the context of cancer, non-medical supportive care improves quality of life. While policymakers expect it to be cheaper than high-tech medical care, we hypothesized that it is in fact embedded in and camouflaged by hospital medical services. METHODS In a cross-sectional descriptive study, we conducted qualitative interviews with healthcare providers, patients and family caregivers in France. We first performed a functional analysis to identify non-medical supportive care functions provided or received and then developed a one day cohort study of patient in hospital or hospital at home to determine which non-medical care functions were provided and in what priority. RESULTS 79 healthcare providers, patients and family caregivers were interviewed and 109 patient files were analysed in the cohort study. Providers declared they were highly solicited for non-medical reasons like moral, emotional support, or respite, that we listed and grouped into 5 categories: physical, moral, or financial support, coordination of care and dealing with legal and technical constraints. The cohort study determined that 30 patients (27%) were hospitalised for non-medical reasons. A diversity of services were provided: physical support (n=4), moral support (n=13), financial support (n=1), coordination of care dysfunction (n=12), legal constraint (n=1). CONCLUSION Medical care is not sufficient for the support of advanced cancer patients. Even though equivalence of care is guaranteed at home, non-medical services are provided within hospital because they are not provided or funded anywhere else. Non-medical care performs a variety of social, financial, psychological and legal functions needed by patients and family caregivers.