Care provided and care setting transitions in the last three months of life of cancer patients: a nationwide monitoring study in four European countriesReportar como inadecuado




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BMC Cancer

, 14:960

Epidemiology, prevention and public health

Abstract

BackgroundThis is an international study across four European countries BelgiumBE, the NetherlandsNL, ItalyIT and SpainES between 2009 and 2011, describing and comparing care and care setting transitions provided in the last three months of life of cancer patients, using representative GP networks.

MethodsGeneral practitioners GPs of representative networks in each country reported weekly all non-sudden cancer deaths +18y within their practice. GPs reported medical end-of-life care, communication and circumstances of dying on a standardised questionnaire. Multivariate logistic regressions BE as a reference category were conducted to compare countries.

ResultsOf 2,037 identified patients from four countries, four out of five lived at home or with family in their last year of life. Over 50% of patients had at least one transition in care settings in the last three months of life; one third of patients in BE, IT and ES had a last week hospital admission and died there. In the last week of life, a treatment goal was adopted for 80-95% of those having palliation-comfort as their treatment goal. Cross-country differences in end-of-life care provision included GPs in NL being more involved in palliative care 67% than in other countries 35%-49% OR 1.9 and end-of-life topics less often discussed in IT or ES. Preference for place of death was less often expressed in IT and ES 32-34% than in BE and NL 49-74%. Of all patients, 88-98% were estimated to have distress from at least one physical symptom in the final week of life.

ConclusionAlthough palliative care was the main treatment goal for most cancer patients at the end of life in all four countries, frequent late hospital admissions and the symptom burden experienced in the last week of life indicates that further integration of palliative care into oncology care is required in many countries.

AbbreviationsGPGeneral practitioners

ORsOdd ratios

EOLEnd-of-life

WHOWorld Health Organisation

BEBelgium

NLthe Netherlands

ITItaly

ESSpain.

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Autor: Winne Ko - Luc Deliens - Guido Miccinesi - Francesco Giusti - Sarah Moreels - Gé A Donker - Bregje Onwuteaka-Philipsen -

Fuente: https://link.springer.com/







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