Terminal care in a semi-rural area.

In six months 157 patients died of malignant disease in West Cumbria, a semi-rural area, following a period of terminal care exceeding a week. A total of 53% of patients died at home compared with 24-41% in studies in metropolitan areas. In addition, over one-third of patients who died in hospital were in for a week or less. Patients living further from hospital were more likely to be cared for at home to the end of their illness. The emotional strain of home care was the commonest problem for the lay carer (74%). The commonest reasons for hospital admission were problems in providing care: in 22% of admissions there was no lay carer and in 45% the lay carer became unable to continue to give care. Nearly half the patients dying in hospital were in acute wards, frequently criticized by nurses and relatives as being unsuitable for dying patients. Despite the high degree of satisfaction expressed for the care provided in all settings, there was evidence of much avoidable suffering. A need for expert advice on palliative care was revealed.