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Hospice-palliative care has existed in Hungary for more than 20 years but physicians know very little about it. The objective of the study is to give detailed practical information about the possibilities and the reasonability of hospice care and the process of how to have access to it. The authors review and analyze the database of the national Hospice-Palliative Association database to provide most recent national data on hospice-palliative care. In addition, legal, financial and educational issues are also discussed. At present there are 90 active hospice providers in Hungary, which provide service for more than 8000 terminally ill cancer patients. According to WHO recommendations there would be a need for much more service providers, institutional supply and more beds. There are also problems concerning the attitude and, therefore, patients are admitted into hospice care too late. Hospice care is often confused with chronic or nursing care due to lack of information. The situation may be improved with proper forms of education such as palliative licence and compulsory, 40-hour palliative training for residents. The authors conclude that a broad dissemination of data may help to overcome misbeliefs concerning hospice and raise awareness concerning death and dying.

Objective: The aim of the study was to evaluate whether family members believed that the decision for home hospice had been the acceptable choice and to identify factors related to families accepting that the decision was good., Methods: In June 2007, a cross-sectional anonymous questionnaire was distributed to bereaved family members of terminal cancer patients in Japan who died at home in the previous 6 months. The questionnaire included questions about whether the family member believed that the decision for home hospice had been the acceptable choice and the decision-making process., Results: A total of 286 responses from 14 home hospices were analyzed. A total of 92% of the participants indicated that the decision for home hospice had been the acceptable choice. Multivariate logistic regression analysis indicated that the following subjects were more likely to believe that the decision for home hospice had been the acceptable choice: those who (i) considered the patient's desire ahead of the family situation (P < 0.001); (ii) decided based on knowledge of all options (P < 0.001); (iii) decided based on agreement with patient, family and medical staff (P = 0.007); (iv) decided based on the patient and family only (P = 0.026); and (v) had patients who were enrolled in home hospice for <60 days (P = 0.032)., Conclusions: It is important to encourage discussion about end-of-life care and to assist the patient and family in the decision-making process by providing information on all available options through open communication.

A microeconomic study evaluated the health sector cost of home care in Greece for patients with malignant neoplasms. A cost-identification analysis was performed from the home care service's perspective. According to the results of the study, the cost varies among the main categories of malignant neoplasms because of a fluctuation in the cost of drugs, whereas the main cost-driver factor is the cost of laboratory tests. In comparison with the corresponding cost of in-hospital care, the cost of home care for patients with malignant neoplasms is significantly lower, which also is confirmed by the results of other international studies.

A videophone system was used to link cancer patients, undergoing chemotherapy at home, with care providers in the Home Healthcare Facility at the University Hospital Centre of Grenoble. The participant patients expressed their satisfaction both with the use and the technical quality of the system. Improvement was observed in the Hospitalisation Anxiety and Depression Scale (HADS), SF36 Health Survey Questionnaire and Palliative care Outpatient Scale (POS) scores during and at the end of the experiment. The results indicated that the use of videophones was both feasible and satisfactory, and that they may have a positive effect on the cancer patient's quality of life at home. Further studies are necessary to prove this final observation.

From April, 1996 to March, 1999, our hospital provided home medical care on a 24-hour basis for fifty patients with advanced or terminal cancer. Eventually, twenty-four patients died at home and twenty-six in the hospital. Stability of health status, the presence of willing and able caregivers, as well as a greater number of house-calls are suggested factors in facilitating a death at home. However, the patients who died in the hospital were obliged to readmit themselves until the time of death due to caregivers' reasons such as fatigue, emotional stress and/or health problems. In addition to timely availability and accessibility of respite care, psychosocial support for family caregivers by liaison nurses remains an issue to be solved in future.