TY - JOUR

T1 - Physician Visits and Recognition of Residents' Terminal Phase in Long-Term Care Facilities

T2 - Findings From the PACE Cross-Sectional Study in 6 EU Countries

AU - PACE

AU - Oosterveld-Vlug, M. G.

AU - Pasman, H. R.W.

AU - ten Koppel, M.

AU - van Hout, H. P.J.

AU - van der Steen, J. T.

AU - Collingridge Moore, D.

AU - Deliens, L.

AU - Gambassi, G.

AU - Kylänen, M.

AU - Smets, T.

AU - Szczerbińska, K.

AU - Van den Block, L.

AU - Onwuteaka-Philipsen, B. D.

N1 - This is the author’s version of a work that was accepted for publication in Journal of the American Medical Directors Association. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Journal of the American Medical Directors Association, 20,6, 2019 DOI: 10.1016/j.jamda.2018.08.015

PY - 2019/6/1

Y1 - 2019/6/1

N2 - Objectives: To describe the relation between physician visits and physicians' recognition of a resident's terminal phase in long-term care facilities (LTCFs) in Belgium, England, Finland, Italy, the Netherlands, and Poland. Design: In each country, a cross-sectional study was conducted across representative samples of LTCFs. Participating LTCFs reported all deaths of residents in the previous 3 months, and structured questionnaires were sent to several proxy respondents including the treating physician. Setting and Participants: 1094 residents in 239 LTCFs, about whom 505 physicians returned the questionnaire. Measures: Number of physician visits, the resident's main treatment goal, whether physicians recognized the resident's terminal phase and expected the resident's death, and resident and physician characteristics. Results: The number of physician visits to residents varied widely between countries, ranging from a median of 15 visits in the last 3 months of life in Poland to 5 in England, and from 4 visits in the last week of life in the Netherlands to 1 in England. Among all countries, physicians from Poland and Italy were least inclined to recognize that the resident was in the terminal phase (63.0% in Poland compared to 80.3% in the Netherlands), and residents in these countries had palliation as main treatment goal the least (31.8% in Italy compared to 92.6% in the Netherlands). Overall however, there were positive associations between the number of physician visits and the recognition of the resident's terminal phase and between the number of physician visits and the resident having palliation as main treatment goal in the last week of life. Conclusions and Implications: This study suggests that LTCFs should be encouraged to work collaboratively with physicians to involve them as much as possible in caring for their residents. Joint working will facilitate the recognition of a resident's terminal phase and the timely provision of palliative care.

AB - Objectives: To describe the relation between physician visits and physicians' recognition of a resident's terminal phase in long-term care facilities (LTCFs) in Belgium, England, Finland, Italy, the Netherlands, and Poland. Design: In each country, a cross-sectional study was conducted across representative samples of LTCFs. Participating LTCFs reported all deaths of residents in the previous 3 months, and structured questionnaires were sent to several proxy respondents including the treating physician. Setting and Participants: 1094 residents in 239 LTCFs, about whom 505 physicians returned the questionnaire. Measures: Number of physician visits, the resident's main treatment goal, whether physicians recognized the resident's terminal phase and expected the resident's death, and resident and physician characteristics. Results: The number of physician visits to residents varied widely between countries, ranging from a median of 15 visits in the last 3 months of life in Poland to 5 in England, and from 4 visits in the last week of life in the Netherlands to 1 in England. Among all countries, physicians from Poland and Italy were least inclined to recognize that the resident was in the terminal phase (63.0% in Poland compared to 80.3% in the Netherlands), and residents in these countries had palliation as main treatment goal the least (31.8% in Italy compared to 92.6% in the Netherlands). Overall however, there were positive associations between the number of physician visits and the recognition of the resident's terminal phase and between the number of physician visits and the resident having palliation as main treatment goal in the last week of life. Conclusions and Implications: This study suggests that LTCFs should be encouraged to work collaboratively with physicians to involve them as much as possible in caring for their residents. Joint working will facilitate the recognition of a resident's terminal phase and the timely provision of palliative care.

KW - End-of-life care

KW - long-term care

KW - nursing home

KW - palliative care

KW - physician visits

KW - terminal phase

U2 - 10.1016/j.jamda.2018.08.015

DO - 10.1016/j.jamda.2018.08.015

M3 - Journal article

AN - SCOPUS:85055182017

VL - 20

SP - 696-702.e1

JO - Journal of the American Medical Directors Association

JF - Journal of the American Medical Directors Association

SN - 1525-8610

IS - 6

ER -