Home-Based Palliative Care for Cancer Patients: Evaluating a Decade of Nursing-Led Interventions

Abstract

Home-based palliative care is an effective approach for managing advanced-stage cancer patients, particularly in regions with limited healthcare infrastructure. In Brazil, the “Better at Home” Program enables interdisciplinary teams to deliver palliative care in patients’ homes, with nurses playing a central role in providing clinical and supportive interventions. This study aimed to characterize the clinical and functional profile of patients receiving home-based palliative care for cancer and to examine the scope and coordination of nursing interventions delivered by Home-based Palliative Care (SAD-CP) teams in Brazil. This retrospective, observational, and quantitative study analyzed 471 medical records of cancer patients assisted by SAD-CP between 2013 and 2023. Variables assessed included sociodemographic and clinical characteristics, nurse functions and interventions, and caregiver training. Patients had a mean age of 69.6 years, with pain (94.7%) and dyspnea (77.1%) being the most commonly reported symptoms. Most patients had a Palliative Performance Scale (PPS) score of ≤50%, indicating high functional dependence. Registered nurses (RNs) were responsible for complex procedures, supervision of nursing technicians (NTs), and caregiver training, while NTs performed routine clinical tasks and assisted with daily care. Structured caregiver education, based on the CARES model, was a prerequisite for patient admission throughout the study period. Notably, 99.4% of patients died at home, suggesting alignment with palliative goals of care. These findings underscore the central role of RNs in coordinating and delivering home-based palliative oncology care within a multidisciplinary framework. The SAD-CP model, combining RN leadership, NT support, and structured caregiver training, demonstrates feasibility and positive impact in a resource-constrained context.