Po1512 Dying At Home: The Role Of The Family Physician

Maria Teresa Silva1
1USF Mactamã
INTRODUCTION: For a long time family physicians (FP) service has included home visits. To date, the development of the Integrative Continued Health Care National Network (ICCNN) in Portugal, allowed for delivering better quality healthcare and for responding to the needs of those patients in a situation of overall care dependence. Several cases can now be dealt with and treated at home rather than within hospital premises. The case at hand reflects such reality by referring to the circumstances of a patient in terminal stage of oncological disease.
CASE DESCRIPTION: Female patient, aged 75, with current health problems of malignant stomach neoplasia following full gastrectomy in 2009, essential hypertension and depressive syndrome. In July 17, 2012 the patient comes to an appointment with the FP complaining from decreased appetite, global abdominal pain and feeling of increased abdominal volume. At the time, chemotherapy treatment was being administrated due to recidive gastric neoplasm, showing low tolerance to treatment. On July 31 a domiciliary consultation is conducted due to progressive health deterioration. The patient was confined to bed, already being fully dependent from family care. Family resources analysis has been conducted and caregivers’ expectations have been addressed in regard to care supply. It was agreed follow up healthcare would be performed at home with support of the family, ICCNN team and FP. For over a month and a half several physician visits took place aiming to evaluation progression or to solve particular occurrences (low tolerance to oral administered therapy, constipation and decubitus ulcer). FP maintained close contact on the interaction among different caregivers and nurses. On September 17 the death is reported to the FP.
DISCUSSION: The aforementioned case illustrates FP role on closely following up the patient at home, as well as in managing available resources needed towards home based care for terminal patients, with special attention to palliative care. This case stands out as an important example on the FP role in such a progressively more recurrent situation in Portugal.
death, home visits, palliative care, mourn