Palliative and end-of-life care in a small Caribbean country: A mortality follow-back study of home deaths.

CONTEXT: Empirical information on circumstances of dying from advanced illness in developing countries remain sparse. Evidence indicates that out-of-hospital end-of-life care can have significant benefits like increased satisfaction for the patient and caregivers, and cost-effective for a healthcare system. Services that are aimed to deliver care at private homes may be a good model for low- and middle-income countries or other low-resourced settings.

OBJECTIVES: To examine specialised, generalist and informal palliative care provision, and to describe the end-of-life care goals and treatments received.

METHOD: A mortality follow-back study with data obtained from general practitioners certifying a random sample of death certificates of adult decedents that occurred between March and August 2018. The questionnaire inquired about the characteristics of care and treatment preceding death.

RESULTS: 309 questionnaires were mailed, the response rate was 31% (N=96), of which 76% were non-sudden deaths. Of these cases, 27.4% received no palliative care, 39.7% received it from a general practitioner, and 6.8% from a specialised palliative care service. Comfort maximization (60.3%) was the main goal of care in the last week of life, and analgesics (53.4%) were the predominant treatment for achieving this goal. In addition, 60.3% received informal palliative care from a family member.

CONCLUSION: The largest part of end-of-life care at home in Trinidad and Tobago is provided by family members, whereas professional caregivers feature less prominently. To ensure quality end-of-life care, better access to analgesics is needed, and adequate support and education for family members as well as general practitioners are highly recommended.