Research output: Contribution to Journal/Magazine › Journal article › peer-review
Research output: Contribution to Journal/Magazine › Journal article › peer-review
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TY - JOUR
T1 - End-of-life care in general practice
T2 - a cross-sectional, retrospective survey of 'cancer', 'organ failure' and 'old-age/dementia' patients
AU - Evans, Natalie
AU - Pasman, H. Roeline W.
AU - Donker, Gé A.
AU - Deliens, Luc
AU - Van den Block, Lieve
AU - Onwuteaka-Philipsen, Bregje
AU - on behalf of EUROIMPACT
AU - Brearley, Sarah
PY - 2014/7
Y1 - 2014/7
N2 - Background:End-of-life care is often provided in primary care settings.Aim:To describe and compare general-practitioner end-of-life care for Dutch patients who died from 'cancer', 'organ failure' and 'old-age or dementia'.Design:A cross-sectional, retrospective survey was conducted within a sentinel network of general practitioners. General practitioners recorded the end-of-life care of all patients who died (1 January 2009 to 31 December 2011). Differences in care between patient groups were analysed using multivariate logistic regressions performed with generalised linear mixed models.Setting/participants:Up to 63 general practitioners, covering 0.8% of the population, recorded the care of 1491 patients.Results:General practitioners personally provided palliative care for 75% of cancer, 38% of organ failure and 64% of old-age/dementia patients (adjusted odds ratio (confidence interval): cancer (reference category); organ failure: 0.28 (0.17, 0.47); old-age/dementia: 0.31 (0.15, 0.63)). In the week before death, 89% of cancer, 77% of organ failure and 86% of old-age/dementia patients received palliative treatments: (adjusted odds ratio (confidence interval): cancer (reference category); old-age/dementia: 0.54 (0.29, 1.00); organ failure: 0.38 (0.16, 0.92)). Options for palliative care were discussed with 81% of cancer, 44% of organ failure and 39% of old-age/dementia patients (adjusted odds ratio (confidence interval): cancer (reference category); old-age/dementia: 0.34 (0.21, 0.57); organ failure: 0.17 (0.08, 0.36)).Conclusion:The results highlight the need to integrate palliative care with optimal disease management in primary practice and to initiate advance care planning early in the chronic disease trajectory to enable all patients to live as well as possible with progressive illness and die with dignity and comfort.
AB - Background:End-of-life care is often provided in primary care settings.Aim:To describe and compare general-practitioner end-of-life care for Dutch patients who died from 'cancer', 'organ failure' and 'old-age or dementia'.Design:A cross-sectional, retrospective survey was conducted within a sentinel network of general practitioners. General practitioners recorded the end-of-life care of all patients who died (1 January 2009 to 31 December 2011). Differences in care between patient groups were analysed using multivariate logistic regressions performed with generalised linear mixed models.Setting/participants:Up to 63 general practitioners, covering 0.8% of the population, recorded the care of 1491 patients.Results:General practitioners personally provided palliative care for 75% of cancer, 38% of organ failure and 64% of old-age/dementia patients (adjusted odds ratio (confidence interval): cancer (reference category); organ failure: 0.28 (0.17, 0.47); old-age/dementia: 0.31 (0.15, 0.63)). In the week before death, 89% of cancer, 77% of organ failure and 86% of old-age/dementia patients received palliative treatments: (adjusted odds ratio (confidence interval): cancer (reference category); old-age/dementia: 0.54 (0.29, 1.00); organ failure: 0.38 (0.16, 0.92)). Options for palliative care were discussed with 81% of cancer, 44% of organ failure and 39% of old-age/dementia patients (adjusted odds ratio (confidence interval): cancer (reference category); old-age/dementia: 0.34 (0.21, 0.57); organ failure: 0.17 (0.08, 0.36)).Conclusion:The results highlight the need to integrate palliative care with optimal disease management in primary practice and to initiate advance care planning early in the chronic disease trajectory to enable all patients to live as well as possible with progressive illness and die with dignity and comfort.
KW - Palliative care
KW - Primary health care
KW - cancer frail elderly
KW - heart failure
KW - chronic obstructive airways disease
U2 - 10.1177/0269216314526271
DO - 10.1177/0269216314526271
M3 - Journal article
C2 - 24642671
VL - 28
SP - 965
EP - 975
JO - Palliative Medicine
JF - Palliative Medicine
SN - 0269-2163
IS - 7
ER -