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Factors associated with dying at the place of wish: a cross-country comparison of cancer patients with the EURO SENTI-MELC Study 2009-2010.
Ko, W., Miccinesi, G., Beccaro, M., Vanthomme, K., Donker, G.A., Onwuteaka-Philipsen, B., Alonso, T.V.A.V, Deliens, L., Block, L. van den. Factors associated with dying at the place of wish: a cross-country comparison of cancer patients with the EURO SENTI-MELC Study 2009-2010. European Journal of Palliative Care: 2013, p. 66. Abstract. In abstractbook. EAPC 2013. 13th World Congress of the European Association for Palliative Care (EAPC). 30 may - 2 june 2013, Prague.
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Aims: 1) To study demographic and clinical factors associated with dying at a preferred place for cancer patients 2) To study cross-country differences in the intensity of factors Methods: A mortality follow-back study was undertaken in 2009-2010 via representative nationwide networks of general practitioners(GPs) in Belgium(BE), the Netherlands(NL), Italy(IT) and Spain(ES). GPs reported aspects of end-of-life care of deceased patients weekly on a standardised questionnaire. All non-sudden cancer deaths aged 18+ were included. Association between 7 factors (age, gender, number of GP contacts, communication about palliative care, GPs provision of palliative care, patients’ treatment wishes, patients’ decision-making capability) and preference met on place of death separately (excluding Spain) was assessed through bivariate and multivariate logistic regressions. Results: A total of 1920 deceased patients were identified. 837 patients were included in the final analyses if GPs were informed about the preference. Over 70% of the sample aged 65 or above, 54% being male and most frequently had lung malignancy. Bivariate analyses showed having more than four contacts with GPs in the last week of life (ORs[95%C.I.]IT:3.0[1.2-7.6], NL:8.0[1.6-39.8], BE:9.3[3.0-28.7]) and receiving GPs provision of palliative care until death (ORs[95%C.I.]: IT:4.2[2.4-7.2], NL:7.4[3.2-17.3], BE:11.6[6.1- 22.2])are the only factors associated with dying at the place of wish. Provision of palliative care by GPs until death remains the only significant factor in the multivariate analyses consistently in all countries. (ORs [95%C.I.]: IT:4.6[2.5-8.5], NL:14.2[-39.8], BE:9.3[3.0-28.7]) Conclusion: Receiving palliative care provided by GPs until death is associated with realising a cancer patient’s preferred place of death after adjusting for demographic and clinical characteristics. Though the cause-and-effect is unclear, the data show GPs’ crucial role in providing primary palliative care in all countries.
Aims: 1) To study demographic and clinical factors associated with dying at a preferred place for cancer patients 2) To study cross-country differences in the intensity of factors Methods: A mortality follow-back study was undertaken in 2009-2010 via representative nationwide networks of general practitioners(GPs) in Belgium(BE), the Netherlands(NL), Italy(IT) and Spain(ES). GPs reported aspects of end-of-life care of deceased patients weekly on a standardised questionnaire. All non-sudden cancer deaths aged 18+ were included. Association between 7 factors (age, gender, number of GP contacts, communication about palliative care, GPs provision of palliative care, patients’ treatment wishes, patients’ decision-making capability) and preference met on place of death separately (excluding Spain) was assessed through bivariate and multivariate logistic regressions. Results: A total of 1920 deceased patients were identified. 837 patients were included in the final analyses if GPs were informed about the preference. Over 70% of the sample aged 65 or above, 54% being male and most frequently had lung malignancy. Bivariate analyses showed having more than four contacts with GPs in the last week of life (ORs[95%C.I.]IT:3.0[1.2-7.6], NL:8.0[1.6-39.8], BE:9.3[3.0-28.7]) and receiving GPs provision of palliative care until death (ORs[95%C.I.]: IT:4.2[2.4-7.2], NL:7.4[3.2-17.3], BE:11.6[6.1- 22.2])are the only factors associated with dying at the place of wish. Provision of palliative care by GPs until death remains the only significant factor in the multivariate analyses consistently in all countries. (ORs [95%C.I.]: IT:4.6[2.5-8.5], NL:14.2[-39.8], BE:9.3[3.0-28.7]) Conclusion: Receiving palliative care provided by GPs until death is associated with realising a cancer patient’s preferred place of death after adjusting for demographic and clinical characteristics. Though the cause-and-effect is unclear, the data show GPs’ crucial role in providing primary palliative care in all countries.
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