Palliative care often deployed too late in chronic conditions

Palliative care encompasses more than terminal care alone, and can be started at an earlier stage. However, in patients with a disease other than cancer – for example those with COPD or the vulnerable elderly – the general practitioner (GP) often only becomes aware of the need for palliative care gradually and at a relatively short time before death. This has been shown by research carried out by physician Susanne Claessen at the Netherlands Institute for Health Services Research (NIVEL) and the EMGO Institute for Health and Care Research. Claessen will be awarded a doctorate for her thesis on this subject at the VU University Medical Center (VUmc), Amsterdam on February 28, 2013.
 

Palliative care is not aimed at cure but at the quality of life of people with a life-threatening, incurable disease. Claessen looked at the question of palliative care and if it was being given in the early stages of a life-threatening illness. This proved to be far from the case, even though it is important in preventing unnecessary hospital admissions and crisis situations. She used questionnaires and interviews with GPs to research this subject. She found that GPs recognize the need for palliative care by a combination of predominantly subtle signals from patients, such as increasing dependence on care and the inability to get better after incidental infections. Signals from family members or information from a medical specialist are also factors that draw a GP’s attention to a patient’s requirement for palliative care.
 
Address it earlier
Susanne Claessen: “GPs know that palliative care can begin before the terminal phase. However, in patients with heart failure or COPD it is sometimes difficult for GPs to see when they should start. In addition, these diseases are often characterized by alternating good and bad periods.” Claessen advocates an approach whereby GPs take the initiative at an early stage to discuss care requirements during the last phase of life with the patient and those closest to them.
 
Measuring quality
In her doctoral thesis, Claessen also examines the development of the quality indicators of palliative care. Quality indicators are measureable aspects of care that give an indication of the quality of care. Susanne Claessen’s research shows that the follow-up care for the surviving relatives scores relatively low on these indicators. Claessen: “Palliative care has developed greatly over the past few years, but much remains to be done for patients with chronic conditions and for the follow-up care of their relatives.”
 
Subsidized by
The Netherlands Organization for Health Research and Development (ZonMw) Palliative Care Program
 
In collaboration with
VUmc/EMGO Institute for Health and Care Research
 
Expert/Contact person
Susanne Claessen +3130 2729700