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- Title
Discussing End-of-Life Issues in the Last Months of Life: A Nationwide Study among General Practitioners.
- Authors
Abarshi, Ebun; Echteld, Michael; Donker, Gé; Van den Block, Lieve; Onwuteaka-Philipsen, Bregje; Deliens, Luc
- Abstract
Background: Communication is a necessary tool for ensuring the provision of quality patient-centered care for patients who have life-threatening illnesses, and discussing all relevant end-of-life issues should not be limited to cancer patients. Objective: To examine the incidence and timing of general practitioners (GPs) discussing end-of-life issues with patients whose deaths were expected, and to identify the factors associated with them discussing these issues. Methods: Between January and December 2008, GPs participating in a nationally representative sentinel surveillance network of GPs were asked to register, using standardised forms, the extent of discussing 10 end-of-life issues with patients. Results: We examined 252 patients who died nonsuddenly, 38% of whom died of cancer, and 86% of whose treatment goal was palliative care. Our findings show that GPs often waited until very close to death before they discussed end-of-life issues with patients, and discussed spiritual and social issues less than physical symptoms, diagnoses, and psychological problems. In 74% of cases, the GPs were informed of their patients' preferred place of death; and 8 out of 10 patients with known preferences for place of death, died there. Being diagnosed with cancer was associated with a higher frequency of discussing all 10 end-of-life issues than diagnosis with other (noncancer) conditions, but this is a state of mind we did not explore in this study. Conclusion: Promotion of timely discussion of all relevant end-of-life issues, in patients with cancer and noncancer diagnoses, is advisable based on systematic needs assessment.
- Subjects
NETHERLANDS; ANALYSIS of variance; CHI-squared test; COMPUTER software; PALLIATIVE treatment; PHYSICIAN-patient relations; GENERAL practitioners; PROBABILITY theory; REGRESSION analysis; RESEARCH funding; STATISTICS; SURVEYS; TUMORS; DATA analysis; PATIENT-centered care
- Publication
Journal of Palliative Medicine, 2011, Vol 14, Issue 3, p323
- ISSN
1096-6218
- Publication type
Article
- DOI
10.1089/jpm.2010.0312