Abstract:
OBJECTIVES: To examine the hospital at home programs for cancer patients globally, and determine the services, target population, model of care, and program characteristics. Additionally, we assessed their applicability and identified barriers and facilitators in the Greek healthcare system.
METHODS: A targeted literature review on hospital at home programs for cancer patients was performed. Searches included PubMed, organization websites, reports, and grey literature (2000-May 2023). Inclusion criteria encompassed adult and pediatric programs, regardless of cancer type and data on each program’s services, eligibility criteria, target population, model of care, and program characteristics were extracted and synthesized narratively.
RESULTS: Hospital at home programs for cancer patients are offered globally, including countries such as Australia, the United Kingdom, the United States, France, Belgium and Sweden. These programs provide various services, including infusion-based programs, symptom management, post-operative care, remote monitoring, and end-of-life care. Eligibility criteria vary, targeting patients needing acute cancer care or chemotherapy. In Greece, hospital at home care primarily focuses on palliative care, excluding end-of-life care, but recent initiatives aim to expand services. Implementation challenges include patient and provider willingness, legal, organizational and reimbursement issues, and patient selection.
CONCLUSIONS: In Greece, while hospital at home care predominantly focuses on palliative care, there is a growing recognition of the need to expand services to include cancer treatment at home. Overcoming barriers and leveraging facilitators are essential for successful implementation. This includes policy development, regulation, and guidance to ensure adequate organization, funding, safety, and sustainability. Key requirements for a successful hospital at home system in Greece include quality standards for facilities and medication home delivery, investment in infrastructure and human resources, implementation of electronic prescribing, and development of standardized triage protocols. Further research is needed to evaluate benefit cost-effectiveness, optimal patient selection criteria, and model of care for different cancer types and stages.