"Our retrospective design and the use of an established representative GP network allowed us to describe these differences on a population-based level in a representative sample of all deaths in Belgium. While retrospective designs may have their limitations to resurrect certain aspects of the treatment histories of dead patients  it is the most appropriate design to make population-based estimates about who received palliative care  . This study also has several limitations. "
[Show abstract][Hide abstract] ABSTRACT: To describe how patients with COPD, heart failure, dementia and cancer differ in frequency and timing of referral to palliative care services.
We performed a population-based study with the Sentinel Network of General Practitioners in Belgium. Of 2405 registered deaths respectively 5%, 4% and 28% were identified as from COPD, heart failure or cancer and 14% were diagnosed with severe dementia. GPs reported use and timing of palliative care services and treatment goals in the final three months of life.
Patients with COPD (20%) were less likely than those with heart failure (34%), severe dementia (37%) or cancer (60%) to be referred to palliative care services (p < 0.001). The median days between referral and death was respectively 10, 12, 14 and 20. Patients with COPD who were not referred more often received treatment with a curative or life-prolonging goal and less often with a palliative or comfort goal than did the other patients who were not referred.
Patients with COPD are underserved in terms of palliative care compared to those with other chronic life-limiting diseases. Awareness of palliative care as an option for patients with COPD needs to increase in palliative care services, physicians and the general public.
Respiratory medicine 06/2013; 107(11). DOI:10.1016/j.rmed.2013.06.003 · 3.09 Impact Factor
"By avoiding including patients that died suddenly and unexpectedly, we will be able to study care that was truly delivered in the context of a dying process. Additionally, while retrospective designs may have their limitations to resurrect certain aspects of the treatment histories of deceased patients , it is the most appropriate design to identify a representative sample of deaths and to make population-based estimates about who received palliative care [49,50]. Prospective follow-up studies cannot follow all patients until death hence leaving patients living the longest underrepresented [23,51]. "
[Show abstract][Hide abstract] ABSTRACT: Background:
Although end-of-life care has become an issue of great clinical and public health concern in Europe and beyond, we lack population-based nationwide data that monitor and compare the circumstances of dying and care received in the final months of life in different countries. The European Sentinel GP Networks Monitoring End of Life Care (EURO SENTIMELC) study was designed to describe and compare the last months of life of patients dying in different European countries. We aim to describe how representative GP networks in the EURO SENTIMELC study operate to monitor end of life care in a country, to describe used methodology, research procedures, representativity and characteristics of the population reached using this methodology.
Nationwide representative Networks of General Practitioners (GPs)--ie epidemiological surveillance systems representative of all GPs in a country or large region of a country--in Belgium, The Netherlands, Italy and Spain continuously registered every deceased patient (>18 year) in their practice, using weekly standardized registration forms, during two consecutive years (2009-2010).
A total of 6858 deaths were registered of which two thirds died non-suddenly (from 62% in The Netherlands to 69% in Spain), representative for the GP populations in the participating countries. Of all non-sudden deaths, between 32% and 44% of deaths were aged 85 or older; between 46% and 54% were female, and between 23% and 49% died at home. Cancer was cause of death in 37% to 53% of non-sudden death cases in the four participating countries.
Via the EURO SENTI-MELC methodology, we can build a descriptive epidemiological database on end-of-life care provision in several EU countries, measuring across setting and diseases. The data can serve as baseline measurement to compare and monitor end-of-life care over time. The use of representative GP networks for end-of-life care monitoring has huge potential in Europe where several of these networks are operational.
BMC Family Practice 06/2013; 14(73). DOI:10.1186/1471-2296-14-73 · 1.67 Impact Factor
"Creating a decedent cohort to retrospectively evaluate services used in a time window prior to death has been criticized (Bach et al. 2004) and defended (Earle and Ayanian 2006; Teno and Mor 2005; Barnato and Lynn 2005) as a method to study end-of-life care. Both sides agree that this approach is reasonable to describe events very close to death (six months is close to death and two weeks is even closer), as used in the present study. "
[Show abstract][Hide abstract] ABSTRACT: This study describes acute care hospital death, physician house calls and home care near the end of life among patients who died of cancer and the factors that are associated with these events and services. It is a population-based retrospective study that uses linked administrative healthcare data. The cohort includes all patients who died of cancer between 2000 and 2004 in Ontario, Canada.Fifty-five per cent of patients died in acute care hospital, 68% received home care in the last 6 months of life and 24% received at least one physician house call in the last 2 weeks of life. Increased age was associated with a decreased likelihood of each event or service. Women were less likely to die in acute care and more likely to receive home care. Residents in low-income neighbourhoods were less likely to receive house calls or home care. Patients who received home care or house calls were less likely to die in acute care.Our observations add to those in the literature, suggesting a need to increase the use of supportive care services at the end of life in hopes of decreasing the need for acute care. They also serve as a baseline for future comparison, which is of particular interest since new government policies directed at end-of-life care were recently introduced.
Healthcare policy = Politiques de sante 02/2010; 5(3):e125-43. DOI:10.12927/hcpol.2013.21644
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