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J Pain Symptom Manage. 2014 Mar;47(3):604-619.e3. doi: 10.1016/j.jpainsymman.2013.04.008. Epub 2013 Aug 7.

End-of-life communication: a retrospective survey of representative general practitioner networks in four countries.

Author information

1
Department of Public and Occupational Health, EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: n.evans@vumc.nl.
2
Regional Palliative Care Network, IRCCS AOU San Martino-IST, Genoa, Italy.
3
Department of Public and Occupational Health, EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands.
4
End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel, Brussels, Belgium.
5
Netherlands Institute of Health Services Research (NIVEL), Utrecht, The Netherlands.
6
Clinical and Descriptive Epidemiology Unit, ISPO Cancer Prevention and Research Institute, Florence, Italy.
7
Italian Society of General Medicine, Florence, Italy.
8
Public Health Directorate, Ministry of Health, Castille and León, Spain.
9
Scientific Institute of Public Health, Brussels, Belgium.
10
Public Health and Research General Directorate, Valencian Regional Health Administration, Valencia, Spain; Higher Public Health Research Centre, Valencia, Madrid, Spain; Spanish Consortium for Research on Epidemiology and Public Health, Madrid, Spain.
11
Department of Public and Occupational Health, EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands; End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel, Brussels, Belgium.

Abstract

CONTEXT:

Effective communication is central to high-quality end-of-life care.

OBJECTIVES:

This study examined the prevalence of general practitioner (GP)-patient discussion of end-of-life topics (according to the GP) in Italy, Spain, Belgium, and The Netherlands and associated patient and care characteristics.

METHODS:

This cross-sectional, retrospective survey was conducted with representative GP networks. Using a standardized form, GPs recorded the health and care characteristics in the last three months of life, and the discussion of 10 end-of-life topics, of all patients who died under their care. The mean number of topics discussed, the prevalence of discussion of each topic, and patient and care characteristics associated with discussions were estimated per country.

RESULTS:

In total, 4396 nonsudden deaths were included. On average, more topics were discussed in The Netherlands (mean=6.37), followed by Belgium (4.45), Spain (3.32), and Italy (3.19). The topics most frequently discussed in all countries were "physical complaints" and the "primary diagnosis," whereas "spiritual and existential issues" were the least frequently discussed. Discussions were most prevalent in The Netherlands, followed by Belgium. The GPs from all countries tended to discuss fewer topics with older patients, noncancer patients, patients with dementia, patients for whom palliative care was not an important treatment aim, and patients for whom their GP had not provided palliative care.

CONCLUSION:

The prevalence of end-of-life discussions varied across the four countries. In all countries, training priorities should include the identification and discussion of spiritual and social problems and early end-of-life discussions with older patients, those with cognitive decline if possible, and those with non-malignant diseases.

KEYWORDS:

Patient-physician communication; cross-national; palliative care; patient participation; terminal illness

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