Palliative Care Service Use in Four European Countries: A Cross-National Retrospective Study via Representative Networks of General Practitioners

Abstract

BackgroundDue 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.MethodsCross-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.ResultsWe 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.ConclusionsAlthough 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.

Hospitalisations at the end of life in four European countries: a population-based study via epidemiological surveillance networks

“…Research has shown that a large number of people with life-threatening illnesses prefer to and could be cared for in community-settings towards the end of life 4 28. Yet the results of our study show that all countries we studied face the challenge that large numbers of people are admitted to hospital towards the end of life.…”

The Family Physician's Perceived Role in Preventing and Guiding Hospital Admissions at the End of Life: A Focus Group Study

“…Family physicians are therefore considered to be instrumental in preventing inappropriate end-of-life hospital admissions. The family physician's gatekeeper role to hospital services is limited in Belgium, 33,34 however, because patients or families may autonomously decide to go to a hospital for specific problems without consulting any family physician. [34][35][36] The aim of this study was to explore the family physicians' perspectives of how they perceive their own role in preventing and guiding end-of-life hospital admissions and the difficulties they experience within such a role.…”

New demands for primary health care in Brazil: palliative care

“…The whole world is going through a demographic transition, with an increase in the number of elderly people and chronic noncommunicable diseases (CNCD) [1][2][3][4] such as cancer, diabetes and cardiovascular diseases, many of them in advanced stages. Because of the technological advances regarding the detection and treatment of these diseases, which once progressed rapidly and led to certain death, they now become chronic conditions, with an increasing number of symptoms and functional decline throughout the years.…”

“…The authors emphasized the importance of greater attention to patients with other conditions or diseases other than cancer, which end up dying without having access to PC. 2 This finding may be related to the fact that cancer has become a chronic disease, with decrease of mortality and improvements in prospects for treatment and cure. A study 14 pointed out that there is a noticeable drop in deaths from cancer in the South, Southeast and Center-West regions of Brazil, but this drop is only apparent in state capitals: the countryside population rates show a statistically significant increase.…”

“…7 In general, the domicile is usually the preferred place for PC in the opinion of patients and family, that is, patients usually prefer to go to their homes in the terminal phase of the disease. 1,8 A study 2 carried out in four European countries identified that people who die at home are more prone to receive PC than people who die in other locations, such as the hospital. A study 11 with the objective of identifying the preferential location for death in patients with advanced-stage cancer in seven European countries (England, Flanders, Germany, Italy, the Netherlands, Portugal and Spain) has identified that 51% of patients in Portugal and 84% of patients in the Netherlands reported that they would like to die at home.…”