Dying fail to get specialist care

Palliative care services in New Zealand focus almost exclusively on people with cancer, while those dying of other conditions are often left without specialised support, says a visiting British psychologist.

Professor Sheila Payne, of the University of Sheffield, said that in Britain about 95 per cent of people referred to hospices had cancer. But only about 25 per cent of total deaths each year were cancer-related.

Professor Payne, a member of a working party that developed a palliative care strategy adopted in Britain this year, said many conditions, such as heart failure, multiple sclerosis, Parkinsons and end-stage renal failure, involved a long period of illness before death.

But often people with those conditions were cared for by their family doctor or in a hospital or rest-home, which generally did not offer the additional services that could improve a person's "quality of life and the quality of their dying".

Professor Payne said palliative care was a "package of care" that took into account a person's symptoms such as pain or breathlessness, their psychological state (they might become depressed or anxious), their social conditions (whether they had the support of family members) and it addressed "spiritual, existential" questions such as "why me?".

It also ensured support for the family while the person was dying and after he or she had died.

Professor Payne, a health psychologist, said people should not have to be suffering from cancer to get treatment at a hospice but hospices, which raised much of their budget through charity, had developed their skills in relation to cancer and worried about opening the "floodgates".

Hospice New Zealand chief executive Ann Martin said hospices were accepting patients with other conditions in greater numbers.

Figures for the 2003-2004 year showed that 14 per cent of all hospice referrals were non-cancer patients. The figure ranged between 2 and 39 per cent, depending on the hospice.

Ms Martin said hospice patients included those with motor neuron disease and renal failure.

Dr Kay Mitchell, an Auckland University psychologist, said palliative care in New Zealand was under-resourced and treatment varied widely.

People who were dying were often sent home or to their rest-home after their symptoms were controlled. Most rest-home staff were not trained in palliative care.

A survey she did last year of 377 private hospitals and rest-homes found 52 per cent had received referrals of dying patients from hospices.

The problem would only worsen with an aging population.

Professor Payne said palliative care should be incorporated into health services, as were child-birth services.

Public funding was needed to train people such as family doctors and district health nurses in the principles of good care for people who were dying.