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Multiplying these percentages by the number of deaths estimates
the number of patients who will have each different symptom in
the last year of life. For example, if there are 250 cancer deaths,
and pain is found in 84% of cancer patients, there will be 210
patients with cancer and pain each year. If there are 750 people
who die from conditions other than cancer, and 67% have pain in
the last year of life, then the district will have around 500
people who die from diseases other than cancer and have pain in
their last year of life. The next example for London Region demonstrates
how this is done for each district, across a wide range of symptoms.
Example
from the London Region: Prevalence of Problems in the Last Year
of Life Where Palliative Care Would Improve the Quality of Life
Consider the
data presented in this table:
Click
here to view a larger text version of Table 16.1
These
estimates suggest that in the London Region there are, each year,
about 13,300 cancer patients who experience pain that requires
treatment in the last year of life, about 8,000 who experience
nausea and/or vomiting, and about 7,400 who experience trouble
breathing or breathlessness. Many other symptoms are also present.
Note that in these data, one patient may have several symptoms.
Among patients
who have conditions other than cancer, estimates suggest that
in London region each year 30,200 experience pain that requires
treatment in the last year of life, 12,200 experience nausea and/or
vomiting, 22,100 experience trouble breathing or breathlessness.
As for cancer patients, many other symptoms are also present.
The table below shows the estimates for each health district.
Again, remember that a single patient may have several symptoms.
However, the total number of patients with symptoms is roughly
double that of cancer patients.
Click
here to view a larger text version of Table 16.2
The
next important steps in the epidemiologically-based needs assessment
is to compare need and experience. Thus we can contrast the numbers
of people who "need" care -- as indicated by the number
with symptoms or problems -- with the numbers of people who actually
receive care, as indicated by the numbers of people known to be
receiving care from different services. Data on those receiving
care might be available from individual services, or medicare
and medicaid files, or nationally collected data.
Once
this is complete then special surveys to further investigate the
needs of particular groups of patients and families, about whom
there is not yet sufficient information, can begin. It might then
also be appropriate to run focus groups of patients and surveys
of professionals to examine need and possible solutions.
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