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Individually Tailored Palliative Care in a Rural Region: A Representative Chart Survey and Physicians' Experiences with Integrated Care
Background: Dying at home represents a special challenge in rural areas. This representative study describes the palliative care for patients in a rural German region. Methods: In a cross-sectional, representative study all physicians of a large rural area were surveyed in terms of their palliative care for a biennial period. In prestructured interviews and chart reviews physicians, practices, and palliative care patients' characteristics were obtained. The data were matched with regional mortality data. Results: According to public data 463 inhabitants died during the biennial period: 248 patients (53.6%) died outside the region's borders including all in-hospital patients, while 215 died within this territory (46.4%). Of the latter, a total of 91 patients (42.3%) received care by the 14 physicians surveyed (on average: 6.6 patients per physician). 89% of families were actively involved in care, especially in multigenerational family scenarios. If family members were not involved, nursing serviceswere active instead. Significant predictors for dying at home were the wish to die at home, a cancer diagnosis, and having family support. Conclusions: This study shows a physician-based, individually tailored, rural palliative care approach which allowed the majority of patients to die at home. Families were documented as an important social resource.
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