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Banner A, Wieser S, Madersbacher S. Resource use in the last year of life of prostate cancer patients-A register-based analysis. Prostate Cancer Prostatic Dis 2024; 27:438-443. [PMID: 37380803 DOI: 10.1038/s41391-023-00685-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/11/2023] [Accepted: 06/14/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Given the paucity of data on the end of life (EOL) of prostate-cancer (PC) patients, we investigated medication prescription patterns and hospitalizations during their final year of life. METHODS The data base of the Österreichische Gesundheitskasse Vienna (ÖGK-W) was used to identify all men who died with the diagnosis PC between 1.1.2015 and 31.12.2021 and who were under androgen deprivation and/or new hormonal therapies. Patient age, prescription patterns and hospitalizations during the last year of life were recorded, odds ratios for age groups were analyzed. RESULTS A total of 1.109 patients were included. ADT was given in 86.7% (n = 962) and NHT in 62.8% (n = 696). Overall, prescription of analgesics increased from 41% (n = 455) during the first to 65.1% (n = 722) in the last quarter of the final year of life. Prescription of NSAIDs was almost consistent (18-20%) whereas the number of patients receiving other non-opioids (paracetamol, metamizole) more than doubled (18 to 39%). Older men had lower prescription rates for NSAID (OR: 0.47, 95% CI: 0.35-0.64), non-opioids (OR: 0.43, 95% CI: 0.32-0.57), opioids (OR: 0.45, 95% CI: 0.34-0.6) and adjuvant analgesics (OR: 0.42, 95% CI: 0.28-0.65). Approximately 2/3 of patients (n = 733) died in the hospital with a median of four hospitalizations in the final year of life. The overall cumulative length of admission was less than 50d in 61.9%, 51-100d in 30.6% and >100d in 7.6%. Younger patients (<70 yrs) were more likely to die in the hospital (OR: 1.66, 95% CI: 1.15-2.39), had a higher median rate of hospitalizations (n = 6) and longer cumulative duration of admissions. CONCLUSIONS Resource use increased during the last year life of PC patients with highest rates in younger men. Hospitalization rates were high and 2/3 died in the hospital, both showed clear age dependency with higher rates, duration and death in the hospital for younger men.
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Affiliation(s)
- Andreas Banner
- Department of Urology, Klinik Favoriten, Vienna, Austria
| | - Sabine Wieser
- Österreichische Gesundheitskasse für Wien (ÖGK-W), Vienna, Austria
| | - Stephan Madersbacher
- Department of Urology, Klinik Favoriten, Vienna, Austria.
- Sigmund-Freud Privat Universität, Vienna, Austria.
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Guo P, Pinto C, Edwards B, Pask S, Firth A, O'Brien S, Murtagh FE. Experiences of transitioning between settings of care from the perspectives of patients with advanced illness receiving specialist palliative care and their family caregivers: A qualitative interview study. Palliat Med 2022; 36:124-134. [PMID: 34477022 PMCID: PMC8793309 DOI: 10.1177/02692163211043371] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Transitions between care settings (hospice, hospital and community) can be challenging for patients and family caregivers and are often an under-researched area of health care, including palliative care. AIM To explore the experience of transitions between care settings for those receiving specialist palliative care. DESIGN Qualitative study using thematic analysis. SETTING/PARTICIPANTS Semi-structured interviews were conducted with adult patients (n = 15) and family caregivers (n = 11) receiving specialist palliative care, who had undergone at least two transitions. RESULTS Four themes were identified. (1) Uncertainty about the new care setting. Most participants reported that lack of information about the new setting of care, and difficulties with access and availability of care in the new setting, added to feelings of uncertainty. (2) Biographical disruption. The transition to the new setting often resulted in changes to sense of independence and identity, and maintaining normality was a way to cope with this. (3) Importance of continuity of care. Continuity of care had an impact on feelings of safety in the new setting and influenced decisions about the transition. (4) Need for emotional and practical support. Most participants expressed a greater need for emotional and practical support, when transitioning to a new setting. CONCLUSIONS Findings provide insights into how clinicians might better negotiate transitions for these patients and family caregivers, as well as improve patient outcomes. The complexity and diversity of transition experiences, particularly among patients and families from different ethnicities and cultural backgrounds, need to be further explored in future research.
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Affiliation(s)
- Ping Guo
- School of Nursing, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Cathryn Pinto
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Beth Edwards
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Sophie Pask
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK.,Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Alice Firth
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Suzanne O'Brien
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Fliss Em Murtagh
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK.,Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
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de Man Y, Atsma F, Oosterveld-Vlug MG, Brom L, Onwuteaka-Philipsen BD, Westert GP, Groenewoud AS. The Intensity of Hospital Care Utilization by Dutch Patients With Lung or Colorectal Cancer in their Final Months of Life. Cancer Control 2019; 26:1073274819846574. [PMID: 31159571 PMCID: PMC6552371 DOI: 10.1177/1073274819846574] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Understanding the overuse and underuse of health-care services in the end-of-life (EoL) phase for patients with lung cancer (LC) and colorectal cancer (CRC) is important, but knowledge is limited. To help identify inappropriate care, we present the health-care utilization profiles for hospital care at the EoL of patients with LC (N = 25 553) and CRC (N = 14 911) in the Netherlands between 2013 and 2015. An administrative database containing all in-hospital health-care activities was analyzed to investigate the association between the number of days patients spent in the emergency department (ED) or intensive care unit (ICU) and their exposure to chemotherapy or radiotherapy. Fewer patients received hospital care as death neared, but their intensity of care increased. In the last month of life, the average numbers of hospital bed days, ICU days, and ER contacts were 9.0, 5.5, and 1.2 for patients with CRC, and 8.9, 6.2 and 1.2 for patients with LC in 2015. On the other hand, the occurrence of palliative consultations ranged from 1% to 4%. Patients receiving chemotherapy 6 months before death spent fewer days in ICU than those who did not receive this treatment (odds ratios: CRC = 0.6 [95% confidence interval: 0.4-0.8] and LC = 0.7 [0.5-0.9]), while those receiving chemotherapy 1 month before death had more ED visits (odds ratios: CRC = 17.2 [11.8-25.0] and LC = 15.8 [12.0-20.9]). Our results showed that patients who were still receiving hospital care when death was near had a high intensity of care, yet palliative consultations were low. Receiving chemotherapy or radiotherapy in the final month of life was significantly associated with more ED and ICU contacts in patients with LC.
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Affiliation(s)
- Yvonne de Man
- 1 Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare, Nijmegen, the Netherlands
| | - Femke Atsma
- 1 Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare, Nijmegen, the Netherlands
| | - Mariska G Oosterveld-Vlug
- 2 Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Expertise Center for Palliatie Care, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
| | - Linda Brom
- 3 IKNL, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands
| | - Bregje D Onwuteaka-Philipsen
- 2 Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Expertise Center for Palliatie Care, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
| | - Gert P Westert
- 1 Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare, Nijmegen, the Netherlands
| | - A Stef Groenewoud
- 1 Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare, Nijmegen, the Netherlands
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The association between PaTz and improved palliative care in the primary care setting: a cross-sectional survey. BMC FAMILY PRACTICE 2019; 20:112. [PMID: 31376833 PMCID: PMC6679548 DOI: 10.1186/s12875-019-1002-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 07/24/2019] [Indexed: 12/04/2022]
Abstract
Background The PaTz-method (acronym for Palliatieve Thuiszorg, palliative care at home) is perceived to improve coordination, continuity and communication in palliative care in the Netherlands. Although important for further implementation, research showing a clear effect of PaTz on patient-related outcomes is scarce. This study aimed to examine perceived barriers and added value of PaTz and its association with improved care outcomes. Methods Ninety-eight Dutch general practitioners and 229 Dutch district nurses filled out an online questionnaire with structured questions on added value and barrier perception of PaTz-participation, and palliative care provided to their most recently deceased patient, distributed online by Dutch medical and nurses’ associations. Data from PaTz-participants and non-participants was compared using Chi-square tests, independent t-tests and logistic regression analyses. Results While both PaTz-participants and non-participants perceived PaTz to be beneficial for knowledge collaboration, coordination and continuity of care, time (or lack thereof) is considered the most important barrier for participation. PaTz-participation is associated with discussing five or more end-of-life topics with patients (OR = 3.16) and with another healthcare provider (OR = 2.55). PaTz-participation is also associated with discussing palliative sedation (OR = 3.85) and euthanasia (OR = 2.97) with another healthcare provider. Significant associations with other care outcomes were not found. Conclusions General practitioners and district nurses feel that participating in a PaTz-group has benefits, but perceive various barriers for participation. While participating in a PaTz-group is associated with improved communication between healthcare providers and with patients, the effect on patient outcomes remains unclear. To stimulate further implementation, future research should focus on the effect of PaTz on tangible care characteristics and how to facilitate participation and remove barriers.
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Ko W, Miccinesi G, Beccaro M, Moreels S, Donker GA, Onwuteaka-Philipsen B, Alonso TV, Deliens L, Van den Block L. Factors Associated with Fulfilling the Preference for Dying at Home among Cancer Patients: The role of General Practitioners. J Palliat Care 2018. [DOI: 10.1177/082585971403000303] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Aim: This study aimed to explore clinical and care-related factors associated with fulfilling cancer patients’ preference for home death across four countries: Belgium (BE), the Netherlands (NL), Italy (IT), and Spain (ES). Methods: A mortality follow-back study was undertaken from 2009 to 2011 via representative networks of general practitioners (GPs). The study included all patients aged 18 and over who had died of cancer and whose home death preference and place of death were known by the GP. Factors associated with meeting home death preference were tested using multivariable logistic regressions. Results: Among 2,048 deceased patients, preferred and actual place of death was known in 42.6 percent of cases. Home death preference met ranged from 65.5 to 90.9 percent. Country-specific factors included older age in BE, and decisionmaking capacity and being female in the NL GPs’ provision of palliative care was positively associated with meeting home death preference. Odds ratios (ORs) were: BE: 9.9 (95 percent confidence interval [CI] 3.7–26.6); NL: 9.7 (2.4–39.9); and IT: 2.6 (1.2–5.5). ORs for Spain are not shown because a multivariate model was not performed. Conclusion: Those who develop policy to facilitate home death need to examine available resources for primary end-of-life care. But: Cette étude avait pour objectif d'examiner les facteurs cliniques associés aux demandes des patients désirant mourir à la maison. Cette re-cherche s'étendait sur quatre pays soit la Belgique, les Pays-Bas, l'Italie, et l'Espagne. Méthode: Par l'inter-médaire des réseaux représentatifs d'omnipraticiens, nous avons pu faire un suivi rétrospectif des mortalités survenues durant les années 2009, 2010, et 2011. Cette étude comprenait les patients agés de 18 ans et plus morts du cancer et dont les médecins connaissaient tout autant les volontés de pouvoir mourir à la maison que l'endroit où les patients étaient morts. Les facteurs correspondants aux préférences des patients ont été validés à l'aide de la méthode statistique de regression logistique à variables multiples. Résultats: Parmi les 2 048 personnes décédées on connaissait, chez 42,6 pourcent d'entre elles, la préférence et l'endroit de la mort. Le choix de mourir à domicile variait de 65,5 pourcent à 90,9 pourcent. Les facteurs spécifiques à certains pays étaient l'âge avancé pour la Belgique et, pour les Pays-Bas, la capacité décisionnelle et le fait d'être de sexe feminin. La prestation des soins palliatifs par les omnipraticiens est associée de façon positive au choix de mourir à la maison. Les rapports de probabilités étaient les suivants: Belgique: 9,9 [95 pourcent d'intervalle de fiabilité (3,7–26,6)], Pays-Bas: 9,7 (2,4–39,9) et l'Italie: 2,6 (1,2–5,5). Les facteurs de probabilité pour l'Espagne ne sont pas indiqués car on n'a pas fait d'analyse selon le modèle multivariable. Conclusion: Les professionnels de la santé ayant pour tâche d'établir les politiques pour faciliter la mort à la maison doivent connnaître toutes les resources dont ils disposent dans leur communauté afin de pouvoir offrir les soins de première ligne à domicile.
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Affiliation(s)
- Winne Ko
- End-of-Life Care Research Group, Room 126, Building K, Department of Family Medicine, Vrije Universiteit Brussel Laarbeeklaan 103, 1090 Brussels, Belgium; and Ghent University, Ghent, Belgium
| | - Guido Miccinesi
- Clinical and Descriptive Epidemiology Unit, Cancer Prevention and Research Institute, ISPO, Florence, Italy
| | - Monica Beccaro
- Regional Palliative Care Network, IRCCS AOU San Martino-IST, Genoa, Italy
| | - Sarah Moreels
- Public Health and Surveillance, Scientific Institute of Public Health, Brussels, Belgium
| | - Gé A. Donker
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, Netherlands
| | - Bregje Onwuteaka-Philipsen
- EMGO Institute for Health and Care Research, Department of Public and Occupational Health; and Palliative Care Expertise Centre, VU University Medical Centre, Amsterdam, Netherlands
| | - Tomás V. Alonso
- Public Health Directorate General, Health Department, Valencia, Spain; L Deliens: End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium; Ghent University, Ghent, Belgium; EMGO Institute for Health and Care Research, Department of Public and Occupational Health; and Palliative Care Expertise Centre, VU University Medical Centre, Amsterdam, Netherlands
| | - Luc Deliens
- End-of-Life Care Research Group and Department of Family Medicine, Vrije Universiteit Brussel, Brussels, Belgium; and Ghent University, Ghent, Belgium
| | - Lieve Van den Block
- Lieve Van den Block, Zeger De Groote, Sarah Brearley, Augusto Caraceni, Joachim Cohen, Massimo Costantini, Anneke Francke, Richard Harding, Irene Higginson, Stein Kaasa, Karen Linden, Guido Miccinesi, Bregje Onwuteaka-Philipsen, Koen Pardon, Roeline Pasman, Sophie Pautex, Sheila Payne, and Luc Deliens
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Voléry I, Schrecker C. Quand la mort revient au domicile. Familles, patients et soignants face à la fin de vie en hospitalisation à domicile (HAD). ANTHROPOLOGIE & SANTÉ 2018. [DOI: 10.4000/anthropologiesante.3681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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How do treatment aims in the last phase of life relate to hospitalizations and hospital mortality? A mortality follow-back study of Dutch patients with five types of cancer. Support Care Cancer 2017; 26:777-786. [PMID: 28936558 PMCID: PMC5785603 DOI: 10.1007/s00520-017-3889-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 09/11/2017] [Indexed: 11/30/2022]
Abstract
Purpose The purpose of this study is to describe and compare the relation between treatment aims, hospitalizations, and hospital mortality for Dutch patients who died from lung, colorectal, breast, prostate, or pancreatic cancer. Methods A mortality follow-back study was conducted within a sentinel network of Dutch general practitioners (GPs), who recorded the end-of-life care of 691 patients who died from one of the abovementioned cancer types between 2009 and 2015. Differences in care by type of cancer were analyzed using multilevel analyses to control for clustering within general practices. Results Among all cancer types, patients with prostate cancer most often and patients with pancreatic cancer least often had a palliative treatment aim a month before death (95% resp. 84%). Prostate cancer patients were also least often admitted to hospital in the last month of life (18.5%) and least often died there (3.1%), whereas lung cancer patients were at the other end of the spectrum with 41.8% of them being admitted to hospital and 22.6% dying in hospital. Having a palliative treatment aim and being older were significantly associated with less hospital admissions, and having a palliative treatment aim, having prostate cancer, and dying in a more recent year were significantly associated with less hospital deaths. Conclusion There is large variation between patients with different cancer types with regard to treatment aims, hospital admissions, and hospital deaths. The results highlight the need for early initiation of GP palliative care to support patients from all cancer types to stay at the place they prefer as long as possible.
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Casotto V, Rolfini M, Ferroni E, Savioli V, Gennaro N, Avossa F, Cancian M, Figoli F, Mantoan D, Brambilla A, Ghiotto MC, Fedeli U, Saugo M. End-of-Life Place of Care, Health Care Settings, and Health Care Transitions Among Cancer Patients: Impact of an Integrated Cancer Palliative Care Plan. J Pain Symptom Manage 2017; 54:167-175. [PMID: 28479411 DOI: 10.1016/j.jpainsymman.2017.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 03/15/2017] [Accepted: 04/05/2017] [Indexed: 10/19/2022]
Abstract
CONTEXT Frequent end-of-life health care setting transitions can lead to an increased risk of fragmented care and exposure to unnecessary treatments. OBJECTIVES We assessed the relationship between the presence and the intensity of an Integrated Cancer Palliative Care (ICPC) plan and the occurrence of multiple transitions during the last month of life. METHODS Decedents of cancer aged 18-85 years residents in two regions of Italy were investigated accessing their integrated administrative data (death certificates, hospital discharges, hospice, and home care records). The principal outcome was defined as having 3+ health care setting transitions during the last month of life. The ICPC plans instituted 90-31 days before death represented the main exposure of interest. RESULTS Of the 17,604 patients, 6698 included in an ICPC, although spending in hospital a median number of only two days (interquartile range 1-2), experienced 1+ (59.8%), 2+ (21.1%), or 3+ (5.9%) health care transitions. Among the latter group, the most common trajectory of care is home-hospital-home-hospital (36.0%). The intensity of the ICPC plan showed a marked protective effect toward the event of 3+ health care setting transitions; the effect is already evident from an intensity of at least one home visit/week (odds ratio 0.73; 95% confidence interval 0.62-0.87). CONCLUSION A well-integrated palliative care approach can be effective in further reducing the percentage of patients who spent many days in hospital and/or undergo frequent and inopportune changes of their care setting during their last month of life.
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Affiliation(s)
| | - Maria Rolfini
- Direzione Sanità e Politiche Sociali, Emilia-Romagna Region, Italy
| | - Eliana Ferroni
- Epidemiological System of the Veneto Region, Padova, Italy.
| | - Valentina Savioli
- Servizio Sistema Informativo Sanità e Politiche Sociali, Emilia-Romagna Region, Italy
| | - Nicola Gennaro
- Epidemiological System of the Veneto Region, Padova, Italy
| | | | | | - Franco Figoli
- Palliative Care Unit, Local Health Unit n. 4, Thiene, Italy
| | | | | | | | - Ugo Fedeli
- Epidemiological System of the Veneto Region, Padova, Italy
| | - Mario Saugo
- Epidemiological System of the Veneto Region, Padova, Italy
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Nilsson J, Blomberg C, Holgersson G, Carlsson T, Bergqvist M, Bergström S. End-of-life care: Where do cancer patients want to die? A systematic review. Asia Pac J Clin Oncol 2017; 13:356-364. [DOI: 10.1111/ajco.12678] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 01/30/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Jonas Nilsson
- Center for Research & Development, Uppsala University/County Council of Gävleborg; Gävle Hospital; Gävle Sweden
- Department of Radiation Sciences & Oncology; Umeå University Hospital; Umeå Sweden
- Department of Radiology; Gävle Hospital; Gävle Sweden
| | - Carl Blomberg
- Department of Oncology; Gävle Hospital; Gävle Sweden
| | - Georg Holgersson
- Center for Research & Development, Uppsala University/County Council of Gävleborg; Gävle Hospital; Gävle Sweden
- Department of Oncology; Gävle Hospital; Gävle Sweden
| | - Tobias Carlsson
- Department of Radiation Sciences & Oncology; Umeå University Hospital; Umeå Sweden
| | - Michael Bergqvist
- Center for Research & Development, Uppsala University/County Council of Gävleborg; Gävle Hospital; Gävle Sweden
- Department of Oncology; Gävle Hospital; Gävle Sweden
- Department of Radiation Sciences & Oncology; Umeå University Hospital; Umeå Sweden
| | - Stefan Bergström
- Center for Research & Development, Uppsala University/County Council of Gävleborg; Gävle Hospital; Gävle Sweden
- Department of Oncology; Gävle Hospital; Gävle Sweden
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de Graaf E, Zweers D, Valkenburg AC, Uyttewaal A, Teunissen SC. Hospice assist at home: does the integration of hospice care in primary healthcare support patients to die in their preferred location - A retrospective cross-sectional evaluation study. Palliat Med 2016; 30:580-6. [PMID: 26814216 DOI: 10.1177/0269216315626353] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND A majority of patients prefer to die at home. Specialist palliative care aims to improve quality of life. Hospice assist at home is a Dutch model of general/specialised palliative care within primary care, collaboratively built by general practitioners and a hospice. AIM The aims of this study are to explore whether hospice assist at home service enables patients at hometo express end-of-life preferences and die in their preferred location. In addition, this study provides insight into symptomburden, stability and early referral. DESIGN A retrospective cross-sectional evaluation study was performed (December 2014-March 2015), using hospice assist at home patient records and documentation. Primary outcome includes congruence between preferred and actual place of death. Secondary outcomes include symptom burden, (in)stability and early identification. SETTING/PARTICIPANTS Between June 2012 and December 2014, 130 hospice assist at home patients, living at home with a life expectancy <1 year, were enrolled. Hospice assist at home, a collaboration between general practitioners, district nurses, trained volunteers and a hospice team, facilitates (1) general practitioner-initiated consultation by Nurse Consultant Hospice, (2) fortnightly interdisciplinary consultations and (3) 24/7 hospice backup for patients, caregivers and professionals. RESULTS A total of 130 patients (62 (48%) men; mean age, 72 years) were enrolled, of whom 107/130 (82%) died and 5 dropped out. Preferred place of death was known for 101/107 (94%) patients of whom 91% patients died at their preferred place of death. CONCLUSION Hospice assist at home service supports patients to die in their preferred place of death. Shared responsibility of proactive care in primary care collaboration enabled patients to express preferences. Hospice care should focus on local teamwork, to contribute to shared responsibilities in providing optimal palliative care.
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Affiliation(s)
- Everlien de Graaf
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands Academic Hospice Demeter, De Bilt, The Netherlands
| | - Daniëlle Zweers
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anna Ch Valkenburg
- Academic Hospice Demeter, De Bilt, The Netherlands Community Health Center, De Bilt, The Netherlands
| | | | - Saskia Ccm Teunissen
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands Academic Hospice Demeter, De Bilt, The Netherlands
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Garralda E, Hasselaar J, Carrasco JM, Van Beek K, Siouta N, Csikos A, Menten J, Centeno C. Integrated palliative care in the Spanish context: a systematic review of the literature. BMC Palliat Care 2016; 15:49. [PMID: 27177608 PMCID: PMC4865984 DOI: 10.1186/s12904-016-0120-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 05/04/2016] [Indexed: 11/10/2022] Open
Abstract
Background Integrated palliative care (IPC) involves bringing together administrative, organisational, clinical and service aspects in order to achieve continuity of care between all actors involved in the care network of patients receiving palliative care (PC) services. The purpose of this study is to identify literature on IPC in the Spanish context, either in cancer or other advanced chronic diseases. Methods Systematic review of the literature about IPC published in Spain between 1995 and 2013. Sources searched included PubMed, Cochrane Library, Cinahl, the national palliative care Journal (Medicina Paliativa), and Google. Evidence on IPC in care models, pathways, guidelines and other relevant documents were searched. Additionally, data were included from expert sources. Elements of IPC were considered based on the definition of IPC and the Emmanuel´s IPC tool. The main inclusion criterion was a comprehensive description of PC integration. Results Out of a total of 2,416 titles screened, 49 were included. We found two models describing IPC interventions achieving continuity and appropriateness of care as a result, 12 guidelines or pathways (most of them with a general approach including cancer and non-cancer and showing a theoretical IPC inclusion as measured by Emmanuel’s tool) and 35 other significant documents as for their context relevance (17 health strategy documents, 14 analytical studies and 4 descriptive documents). These last documents comprised respectively: regional and national plans with an IPC inclusion evidence, studies focused on IPC into primary care and resource utilisation; and descriptions of fruitful collaboration programmes between PC teams and oncology departments. Conclusions The results show that explications of IPC in the Spanish literature exist, but that there is insufficient evidence of its impact in clinical practice. This review may be of interest for Spanish-speaking countries and for others seeking to know the status of IPC in the literature in their home nations. Electronic supplementary material The online version of this article (doi:10.1186/s12904-016-0120-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eduardo Garralda
- Atlantes Research Programme, Institute for Culture and Society, University of Navarra, Campus Universitario, 31009, Pamplona, Navarra, Spain. .,Instituto de investigación sanitaria de Navarra (IdiSNA), Pamplona, Navarra, Spain.
| | - Jeroen Hasselaar
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - José Miguel Carrasco
- Atlantes Research Programme, Institute for Culture and Society, University of Navarra, Campus Universitario, 31009, Pamplona, Navarra, Spain.,Instituto de investigación sanitaria de Navarra (IdiSNA), Pamplona, Navarra, Spain
| | - Karen Van Beek
- Department of Radiation-Oncology and Palliative Medicine, University Hospital Gasthuisberg, Leuven, Belgium
| | - Naouma Siouta
- Department of Radiation-Oncology and Palliative Medicine, University Hospital Gasthuisberg, Leuven, Belgium
| | - Agnes Csikos
- Faculty of Medicine, Institute of Family Medicine, University of Pécs Medical School, Pécs, Hungary
| | - Johan Menten
- Department of Radiation-Oncology and Palliative Medicine, University Hospital Gasthuisberg, Leuven, Belgium
| | - Carlos Centeno
- Atlantes Research Programme, Institute for Culture and Society, University of Navarra, Campus Universitario, 31009, Pamplona, Navarra, Spain.,Instituto de investigación sanitaria de Navarra (IdiSNA), Pamplona, Navarra, Spain
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12
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Okamoto Y, Fukui S, Yoshiuchi K, Ishikawa T. Do Symptoms among Home Palliative Care Patients with Advanced Cancer Decide the Place of Death? Focusing on the Presence or Absence of Symptoms during Home Care. J Palliat Med 2016; 19:488-95. [DOI: 10.1089/jpm.2015.0184] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Affiliation(s)
- Yuko Okamoto
- Department of Community Health Nursing, Graduate School of Nursing, Japanese Red Cross University, Tokyo, Japan
| | - Sakiko Fukui
- Department of Community Health Nursing, Graduate School of Nursing, Japanese Red Cross University, Tokyo, Japan
| | - Kazuhiro Yoshiuchi
- Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takako Ishikawa
- Department of Community Health Nursing, Graduate School of Nursing, Japanese Red Cross University, Tokyo, Japan
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13
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Pivodic L, Pardon K, Miccinesi G, Vega Alonso T, Moreels S, Donker GA, Arrieta E, Onwuteaka-Philipsen BD, Deliens L, Van den Block L. Hospitalisations at the end of life in four European countries: a population-based study via epidemiological surveillance networks. J Epidemiol Community Health 2015; 70:430-6. [DOI: 10.1136/jech-2015-206073] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 10/30/2015] [Indexed: 11/04/2022]
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van der Plas AGM, Vissers KC, Francke AL, Donker GA, Jansen WJJ, Deliens L, Onwuteaka-Philipsen BD. Involvement of a Case Manager in Palliative Care Reduces Hospitalisations at the End of Life in Cancer Patients; A Mortality Follow-Back Study in Primary Care. PLoS One 2015. [PMID: 26208099 PMCID: PMC4514754 DOI: 10.1371/journal.pone.0133197] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Case managers have been introduced in primary palliative care in the Netherlands; these are nurses with expertise in palliative care who offer support to patients and informal carers in addition to the care provided by the general practitioner (GP) and home-care nurse. Objectives To compare cancer patients with and without additional support from a case manager on: 1) the patients’ general characteristics, 2) characteristics of care and support given by the GP, 3) palliative care outcomes. Methods This article is based on questionnaire data provided by GPs participating in two different studies: the Sentimelc study (280 cancer patients) and the Capalca study (167 cancer patients). The Sentimelc study is a mortality follow-back study amongst a representative sample of GPs that monitors the care provided via GPs to a general population of end-of-life patients. Data from 2011 and 2012 were analysed. The Capalca study is a prospective study investigating the implementation and outcome of the support provided by case managers in primary palliative care. Data were gathered between March 2011 and December 2013. Results The GP is more likely to know the preferred place of death (OR 7.06; CI 3.47-14.36), the place of death is more likely to be at the home (OR 2.16; CI 1.33-3.51) and less likely to be the hospital (OR 0.26; CI 0.13-0.52), and there are fewer hospitalisations in the last 30 days of life (none: OR 1.99; CI 1.12-3.56 and one: OR 0.54; CI 0.30-0.96), when cancer patients receive additional support from a case manager compared with patients receiving the standard GP care. Conclusions Involvement of a case manager has added value in addition to palliative care provided by the GP, even though the role of the case manager is ‘only’ advisory and he or she does not provide hands-on care or prescribe medication.
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Affiliation(s)
- Annicka G. M. van der Plas
- Department of Public and Occupational Health, VU University Medical Center, Amsterdam, the Netherlands
- Center of Expertise in Palliative Care, VU University Medical Center, Amsterdam, the Netherlands
- EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
- * E-mail:
| | - Kris C. Vissers
- Department of Anaesthesiology, Pain, and Palliative Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Anneke L. Francke
- Department of Public and Occupational Health, VU University Medical Center, Amsterdam, the Netherlands
- Center of Expertise in Palliative Care, VU University Medical Center, Amsterdam, the Netherlands
- EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
- Nursing Care, NIVEL Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Gé A. Donker
- NIVEL Primary Care Database, Sentinel Practices, Utrecht, the Netherlands
| | - Wim J. J. Jansen
- Center of Expertise in Palliative Care, VU University Medical Center, Amsterdam, the Netherlands
- Department of Anaesthesiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussel and Ghent, Belgium
| | - Bregje D. Onwuteaka-Philipsen
- Department of Public and Occupational Health, VU University Medical Center, Amsterdam, the Netherlands
- Center of Expertise in Palliative Care, VU University Medical Center, Amsterdam, the Netherlands
- EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
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15
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Van den Block L, Pivodic L, Pardon K, Donker G, Miccinesi G, Moreels S, Vega Alonso T, Deliens L, Onwuteaka-Philipsen B. Transitions between health care settings in the final three months of life in four EU countries. Eur J Public Health 2015; 25:569-75. [DOI: 10.1093/eurpub/ckv039] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Reyniers T, Houttekier D, Pasman HR, Stichele RV, Cohen J, Deliens L. The family physician's perceived role in preventing and guiding hospital admissions at the end of life: a focus group study. Ann Fam Med 2014; 12:441-6. [PMID: 25354408 PMCID: PMC4157981 DOI: 10.1370/afm.1666] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Family physicians play a pivotal role in providing end-of-life care and in enabling terminally ill patients to die in familiar surroundings. The purpose of this study was to explore the family physicians' perceptions of their role and the difficulties they have in preventing and guiding hospital admissions at the end of life. METHODS Five focus groups were held with family physicians (N= 39) in Belgium. Discussions were transcribed verbatim and analyzed using a constant comparative approach. RESULTS Five key roles in preventing and guiding hospital admissions at the end of life were identified: as a care planner, anticipating future scenarios; as an initiator of decisions in acute situations, mostly in an advisory manner; as a provider of end-of-life care, in which competency and attitude is considered important; as a provider of support, particularly by being available during acute situations; and as a decision maker, taking overall responsibility. CONCLUSIONS Family physicians face many different and complex roles and difficulties in preventing and guiding hospital admissions at the end of life. Enhancing the family physician's role as a gatekeeper to hospital services, offering the physicians more end-of-life care training, and developing or expanding initiatives to support them could contribute to a lower proportion of hospital admissions at the end of life.
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Affiliation(s)
- Thijs Reyniers
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
| | - Dirk Houttekier
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
| | - H Roeline Pasman
- EMGO Institute for Health and Care Research and Expertise Center for Palliative Care, VU University Medical Center, Amsterdam, The Netherlands
| | - Robert Vander Stichele
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium Heymans Institute of Pharmacology, Ghent University, Ghent, Belgium
| | - Joachim Cohen
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
| | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium EMGO Institute for Health and Care Research and Expertise Center for Palliative Care, VU University Medical Center, Amsterdam, The Netherlands
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17
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Kulkarni P, Kulkarni P, Anavkar V, Ghooi R. Preference of the place of death among people of pune. Indian J Palliat Care 2014; 20:101-6. [PMID: 25125864 PMCID: PMC4129995 DOI: 10.4103/0973-1075.132620] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Aim: Provision of end-of-life care requires that we have adequate information about the preferred place of death in the population. Since no such study is reported in India, this study was taken up in and around Pune, a large cosmopolitan city. Setting and Design: A questionnaire was designed in three parts and distributed among the people above the age of 18 in and around Pune. Materials and Methods: The questionnaire had three parts the first being a consent form, followed by one for collection of personal information and lastly questions specific to the subject matter. Filled forms were screened for inconsistencies, gaps of information and errors. Results: The population survey was mixed, both urban and rural, men and women, educated and uneducated, young and old. Despite this heterogeneity, the results were consistent to the point that most of the people surveyed preferred home as the place of death. This preference cuts across all barriers, the only difference being that women had a stronger preference for home death compared to men. Conclusions: Helping people to die at their preferred place is a part of end-of-life care. Majority of people surveyed by us, prefer to die at home, where they are relatively more comfortable. Public and governmental policies should be directed toward facilitating home deaths.
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Affiliation(s)
- Priyadarshini Kulkarni
- Departments of Research and Training, Cipla Palliative Care and Training Centre, Pune, Maharashtra, India
| | - Pradeep Kulkarni
- Departments of Research and Training, Cipla Palliative Care and Training Centre, Pune, Maharashtra, India
| | - Vrushali Anavkar
- Departments of Research and Training, Cipla Palliative Care and Training Centre, Pune, Maharashtra, India
| | - Ravindra Ghooi
- Departments of Research and Training, Cipla Palliative Care and Training Centre, Pune, Maharashtra, India
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18
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De Korte-Verhoef MC, Pasman HRW, Schweitzer BP, Francke AL, Onwuteaka-Philipsen BD, Deliens L. General practitioners' perspectives on the avoidability of hospitalizations at the end of life: A mixed-method study. Palliat Med 2014; 28:949-958. [PMID: 24694377 DOI: 10.1177/0269216314528742] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Many patients are hospitalized in the last months of life. Little is known about the avoidability of these hospitalizations. AIM To explore whether and how hospitalizations could have been avoided in the last 3 months of life and barriers to avoid this, according to general practitioners in the Netherlands. DESIGN Sequential mixed-method design, starting with a cross-sectional nationwide questionnaire study among general practitioners, followed by in-depth interviews. SETTING/PARTICIPANTS General practitioners were asked about their most recent patient who died non-suddenly and who was hospitalized in the last 3 months of life. Additionally, 18 of these general practitioners were interviewed in depth about the situation surrounding hospitalization. RESULTS According to 24% of 319 general practitioners, the last hospitalization in the final 3 months of their patient's life could have been avoided. Of all avoidable hospitalizations, 46% could have been avoided by proactive communication with the patient, 36% by more communication between professionals around hospitalization, 28% by additional care and treatment at home, and 10% by patient and family support. In the in-depth interviews, general practitioners confirmed the aforementioned strategies, but also mentioned various barriers in daily practice, such as the timing of proactive communication with the patient, incompleteness of information transfer in acute situations, and the lack of awareness among patients and family that death was near. CONCLUSION A proactive approach could avoid some of the hospitalizations at the end of life, in the opinion of general practitioners. More insight is needed into communication and psychological barriers for timely discussions about end-of-life issues.
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Affiliation(s)
- Maria C De Korte-Verhoef
- Department of Public and Occupational Health & Expertise Center Palliative Care VUmc, EMGO Institute for Health and Care Research, VU University Medical Center (VUmc), Amsterdam, The Netherlands
| | - H Roeline W Pasman
- Department of Public and Occupational Health & Expertise Center Palliative Care VUmc, EMGO Institute for Health and Care Research, VU University Medical Center (VUmc), Amsterdam, The Netherlands
| | - Bart Pm Schweitzer
- Department of General Practice, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Anneke L Francke
- Department of Public and Occupational Health & Expertise Center Palliative Care VUmc, EMGO Institute for Health and Care Research, VU University Medical Center (VUmc), Amsterdam, The Netherlands Netherlands Institute for Health Services Research, NIVEL, Utrecht, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health & Expertise Center Palliative Care VUmc, EMGO Institute for Health and Care Research, VU University Medical Center (VUmc), Amsterdam, The Netherlands
| | - Luc Deliens
- Department of Public and Occupational Health & Expertise Center Palliative Care VUmc, EMGO Institute for Health and Care Research, VU University Medical Center (VUmc), Amsterdam, The Netherlands End-of-life Care Research Group, Ghent University & Vrije Universiteit Brussel, Brussels, Belgium
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De Roo ML, Miccinesi G, Onwuteaka-Philipsen BD, Van Den Noortgate N, Van den Block L, Bonacchi A, Donker GA, Lozano Alonso JE, Moreels S, Deliens L, Francke AL. Actual and preferred place of death of home-dwelling patients in four European countries: making sense of quality indicators. PLoS One 2014; 9:e93762. [PMID: 24714736 PMCID: PMC3979710 DOI: 10.1371/journal.pone.0093762] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 03/08/2014] [Indexed: 11/19/2022] Open
Abstract
Background Dying at home and dying at the preferred place of death are advocated to be desirable outcomes of palliative care. More insight is needed in their usefulness as quality indicators. Our objective is to describe whether “the percentage of patients dying at home” and “the percentage of patients who died in their place of preference” are feasible and informative quality indicators. Methods and Findings A mortality follow-back study was conducted, based on data recorded by representative GP networks regarding home-dwelling patients who died non-suddenly in Belgium (n = 1036), the Netherlands (n = 512), Italy (n = 1639) or Spain (n = 565). “The percentage of patients dying at home” ranged between 35.3% (Belgium) and 50.6% (the Netherlands) in the four countries, while “the percentage of patients dying at their preferred place of death” ranged between 67.8% (Italy) and 86.0% (Spain). Both indicators were strongly associated with palliative care provision by the GP (odds ratios of 1.55–13.23 and 2.30–6.63, respectively). The quality indicator concerning the preferred place of death offers a broader view than the indicator concerning home deaths, as it takes into account all preferences met in all locations. However, GPs did not know the preferences for place of death in 39.6% (the Netherlands) to 70.3% (Italy), whereas the actual place of death was known in almost all cases. Conclusion GPs know their patients’ actual place of death, making the percentage of home deaths a feasible indicator for collection by GPs. However, patients’ preferred place of death was often unknown to the GP. We therefore recommend using information from relatives as long as information from GPs on the preferred place of death is lacking. Timely communication about the place where patients want to be cared for at the end of life remains a challenge for GPs.
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Affiliation(s)
- Maaike L. De Roo
- Department of Public and Occupational Health, Expertise Center of Palliative Care, VU University medical center, EMGO Institute for Health and Care Research, Amsterdam, the Netherlands
- * E-mail:
| | - Guido Miccinesi
- Clinical and Descriptive Epidemiology Unit, Cancer Prevention and Research Institute (L’Istituto per lo Studio e la Prevenzione Oncologica, ISPO), Florence, Italy
| | - Bregje D. Onwuteaka-Philipsen
- Department of Public and Occupational Health, Expertise Center of Palliative Care, VU University medical center, EMGO Institute for Health and Care Research, Amsterdam, the Netherlands
| | | | - Lieve Van den Block
- End-of-life Care Research Group Vrije Universiteit Brussel (VUB) and Ghent University, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Andrea Bonacchi
- Clinical and Descriptive Epidemiology Unit, Cancer Prevention and Research Institute (L’Istituto per lo Studio e la Prevenzione Oncologica, ISPO), Florence, Italy
| | - Gé A. Donker
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Jose E. Lozano Alonso
- Public Health Directorate General, Regional Ministry of Health, Government of Castilla y León, Valladolid, Spain
| | - Sarah Moreels
- Health Services Research, Scientific Institute of Public Health, Public Health and Surveillance (WIV-ISP, Wetenschappelijk Instituut Volksgezondheid, Institut Scientifique de Santé Publique), Brussels, Belgium
| | - Luc Deliens
- Department of Public and Occupational Health, Expertise Center of Palliative Care, VU University medical center, EMGO Institute for Health and Care Research, Amsterdam, the Netherlands
- End-of-life Care Research Group Vrije Universiteit Brussel (VUB) and Ghent University, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Anneke L. Francke
- Department of Public and Occupational Health, Expertise Center of Palliative Care, VU University medical center, EMGO Institute for Health and Care Research, Amsterdam, the Netherlands
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
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20
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Pivodic L, Van den Block L, Pardon K, Miccinesi G, Vega Alonso T, Boffin N, Donker GA, Cancian M, López-Maside A, Onwuteaka-Philipsen BD, Deliens L. Burden on family carers and care-related financial strain at the end of life: a cross-national population-based study. Eur J Public Health 2014; 24:819-26. [PMID: 24642602 PMCID: PMC4168044 DOI: 10.1093/eurpub/cku026] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The rising number of deaths from cancer and other life-limiting illnesses is accompanied by a growing number of family carers who provide long-lasting care, including end-of-life care. This population-based epidemiological study aimed to describe and compare in four European countries the prevalence of and factors associated with physical or emotional overburden and difficulties in covering care-related costs among family carers of people at the end of life. Methods: A cross-national retrospective study was conducted via nationwide representative sentinel networks of general practitioners (GPs). Using a standardized form, GPs in Belgium, The Netherlands, Italy and Spain recorded information on the last 3 months of life of every deceased adult practice patient (1 January 2009–31 December 2010). Sudden deaths were excluded. Results: We studied 4466 deaths. GPs judged family carers of 28% (Belgium), 30% (The Netherlands), 35% (Spain) and 71% (Italy) of patients as physically/emotionally overburdened (P < 0.001). For 8% (Spain), 14% (Belgium), 36% (The Netherlands) and 43% (Italy) patients, GPs reported difficulties in covering care-related costs (P < 0.001). Patients <85 years of age (Belgium, Italy) had higher odds of having physically/emotionally overburdened family carers and financial burden. Death from non-malignant illness (vs. cancer) (Belgium and Italy) and dying at home compared with other locations (The Netherlands and Italy) were associated with higher odds of difficulties in covering care-related costs. Conclusion: In all countries studied, and particularly in Italy, GPs observed a considerable extent of physical/emotional overburden as well as difficulties in covering care-related costs among family carers of people at the end of life. Implications for health- and social care policies are discussed.
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Affiliation(s)
- Lara Pivodic
- 1 End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Lieve Van den Block
- 1 End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Koen Pardon
- 1 End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Guido Miccinesi
- 2 Cancer Prevention and Research Institute (ISPO), Florence, Italy
| | - Tomás Vega Alonso
- 3 Public Health Directorate, Ministry of Health, Autonomous Community of Castile and Leon, Valladolid, Spain
| | - Nicole Boffin
- 4 Scientific Institute of Public Health, Brussels, Belgium
| | - Gé A Donker
- 5 NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Maurizio Cancian
- 6 SIMG, Italian College of General Practitioners, Florence, Italy
| | - Aurora López-Maside
- 7 Public Health General Directorate, Health Department, Valencian Community, Valencia, Spain
| | - Bregje D Onwuteaka-Philipsen
- 8 Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Luc Deliens
- 1 End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium 8 Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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21
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Pivodic L, Pardon K, Van den Block L, Van Casteren V, Miccinesi G, Donker GA, Alonso TV, Alonso JL, Aprile PL, Onwuteaka-Philipsen BD, Deliens L. Palliative care service use in four European countries: a cross-national retrospective study via representative networks of general practitioners. PLoS One 2013; 8:e84440. [PMID: 24386381 PMCID: PMC3875565 DOI: 10.1371/journal.pone.0084440] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 11/22/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Due to a rising number of deaths from cancer and other chronic diseases a growing number of people experience complex symptoms and require palliative care towards the end of life. However, population-based data on the number of people receiving palliative care in Europe are scarce. The objective of this study is to examine, in four European countries, the number of people receiving palliative care in the last three months of life and the factors associated with receiving palliative care. METHODS Cross-national retrospective study. Over two years (2009-2010), GPs belonging to representative epidemiological surveillance networks in Belgium, the Netherlands, Italy, and Spain registered weekly all deaths of patients (≥ 18 years) in their practices and the care they received in the last three months of life using a standardized form. Sudden deaths were excluded. RESULTS We studied 4,466 deaths. GPs perceived to have delivered palliative care to 50% of patients in Belgium, 55% in Italy, 62% in the Netherlands, and 65% in Spain (p<.001). Palliative care specialists attended to 29% of patients in the Netherlands, 39% in Italy, 45% in Spain, and 47% in Belgium (p<.001). Specialist palliative care lasted a median (inter-quartile range) of 15 (23) days in Belgium to 30 (70) days in Italy (p<.001). Cancer patients were more likely than non-cancer patients to receive palliative care in all countries as were younger patients in Italy and Spain with regard to specialist palliative care. CONCLUSIONS Although palliative care is established in the countries studied, there are considerable differences in its provision. Two potentially underserved groups emerge non-cancer patients in all countries and older people in Italy and Spain. Future research should examine how differences in palliative care use relate to both patient characteristics and existing national health care policies.
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Affiliation(s)
- Lara Pivodic
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Koen Pardon
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Lieve Van den Block
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Viviane Van Casteren
- Scientific Institute of Public Health (Wetenschappelijk Instituut Volksgezondheid, Institut Scientifique de Santé Publique), Unit of Health Services Research, Brussels, Belgium
| | - Guido Miccinesi
- Clinical and Descriptive Epidemiology Unit, Cancer Prevention and Research Institute, Florence, Italy
| | - Gé A. Donker
- Dutch Sentinel General Practice Network, NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Tomás Vega Alonso
- Public Health General Directorate, Regional Ministry of Health (Dirección General de Salud Pública, Consejería de Sanidad), Castile and Leon, Valladolid, Spain
| | - José Lozano Alonso
- Public Health General Directorate, Regional Ministry of Health (Dirección General de Salud Pública, Consejería de Sanidad), Castile and Leon, Valladolid, Spain
| | - Pierangelo Lora Aprile
- Italian Society of General Medicine (Società Italiana di Medicina Generale), Florence, Italy
| | - Bregje D. Onwuteaka-Philipsen
- Department of Public and Occupational Health, EMGO+ Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
- Department of Public and Occupational Health, EMGO+ Institute, VU University Medical Center, Amsterdam, The Netherlands
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