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PLoS One. 2014 Apr 8;9(4):e93762. doi: 10.1371/journal.pone.0093762. eCollection 2014.

Actual and preferred place of death of home-dwelling patients in four European countries: making sense of quality indicators.

Author information

1
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.
2
Clinical and Descriptive Epidemiology Unit, Cancer Prevention and Research Institute (L'Istituto per lo Studio e la Prevenzione Oncologica, ISPO), Florence, Italy.
3
Department of Geriatrics, Ghent University Hospital, Ghent, Belgium.
4
End-of-life Care Research Group Vrije Universiteit Brussel (VUB) and Ghent University, Vrije Universiteit Brussel (VUB), Brussels, Belgium.
5
NIVEL, Netherlands Institute for Health Services Research, Utrecht, the Netherlands.
6
Public Health Directorate General, Regional Ministry of Health, Government of Castilla y León, Valladolid, Spain.
7
Health Services Research, Scientific Institute of Public Health, Public Health and Surveillance (WIV-ISP, Wetenschappelijk Instituut Volksgezondheid, Institut Scientifique de Santé Publique), Brussels, Belgium.
8
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.
9
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.

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.

PMID:
24714736
PMCID:
PMC3979710
DOI:
10.1371/journal.pone.0093762
[Indexed for MEDLINE]
Free PMC Article

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