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Background
In the past two decades, palliative care for the terminally ill has developed substantially in hospital settings as well as in the community, including home hospice care. This development reflects the rise in the number of patients receiving care as well as the shift from exclusively treating patients with cancer to treating patients diagnosed with other terminal illnesses such as incapacitating congestive cardiac failure. 1
Case presentation
An 82-year-old, retired lawyer, married, having two daughters and seven grandchildren was diagnosed with congestive heart failure (CHF) for 27 years. During the last year of his life the heart failure worsened as he experienced a myocardial infarction. In addition to maximal doses of ACE inhibitors, [beta]-blockers and diuretics, he also had a dual chamber pacemaker inserted in an effort to improve his cardiac output. During the 6 months before admission to the home hospice unit he had been hospitalised eight times due to severe exacerbations of heart failure. His last echocardiogram estimated an ejection fraction of 12%. He had been experiencing rapid increase of fluid retention which was clinically presented as anasarca. After consulting his cardiologist and with support from his family, he requested for treatment in his own home under the supervision of our home hospice team.
On the first home visit of the hospice team to the patient, a complete palliative care assessment was performed by a physician and a nurse. The team was satisfied that the patient had understood the concept of palliative and hospice care and he expressed his wish to remain at home for the remainder of his days. A few objective tools were used to assess the patient's symptoms, including a Palliative care Outcome Scale-Symptoms questioner (POS-S), specifically designed for the assessment of patients with a deterioration during a prolonged chronic illness and experiencing multiple symptoms. The patient indicated a score of 3 (on a...