Send to

Choose Destination
Palliat Med. 2019 Jul 1:269216319861229. doi: 10.1177/0269216319861229. [Epub ahead of print]

Palliative care provision in long-term care facilities differs across Europe: Results of a cross-sectional study in six European countries (PACE).

Author information

1 Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.
2 Center of Expertise in Palliative Care, VU University Medical Center, Amsterdam, The Netherlands.
3 End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.
4 Istituto di Medicina Interna e Geriatria, Università Cattolica del Sacro Cuore, Rome, Italy.
5 Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.
6 National Institute for Health and Welfare, Helsinki, Finland.
7 International Observatory on End-of-Life Care, Lancaster University, Lancaster, UK.
8 Unit for Research on Aging Society, Department of Sociology of Medicine, Chair of Epidemiology and Preventive Medicine, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland.
9 Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
10 Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.



While the need for palliative care in long-term care facilities is growing, it is unknown whether palliative care in this setting is sufficiently developed.


To describe and compare in six European countries palliative care provision in long-term care facilities and to assess associations between patient, facility and advance care planning factors and receipt and timing of palliative care.


Cross-sectional after-death survey regarding care provided to long-term care residents in Belgium, England, Finland, Italy, the Netherlands and Poland. Generalized estimating equations were used for analyses.


Nurses or care assistants who are most involved in care for the resident.


We included 1298 residents in 300 facilities, of whom a majority received palliative care in most countries (England: 72.6%-Belgium: 77.9%), except in Poland (14.0%) and Italy (32.1%). Palliative care typically started within 2 weeks before death and was often provided by the treating physician (England: 75%-the Netherlands: 98.8%). A palliative care specialist was frequently involved in Belgium and Poland (57.1% and 86.7%). Residents with cancer, dementia or a contact person in their record more often received palliative care, and it started earlier for residents with whom the nurse had spoken about treatments or the preferred course of care at the end of life.


The late initiation of palliative care (especially when advance care planning is lacking) and palliative care for residents without cancer, dementia or closely involved relatives deserve attention in all countries. Diversity in palliative care organization might be related to different levels of its development.


Nursing homes; aged; aged 80 and over; cross-sectional studies; long-term care; palliative care; residential facilities; retrospective studies


Supplemental Content

Full text links

Icon for Atypon
Loading ...
Support Center