What are important treatment aims in the last three months of life?

Claessen, S.J.J., Echteld, M.A., Francke, A.L., Block, L. van den, Donker, G.A., Deliens, L. What are important treatment aims in the last three months of life? European Journal of Palliative Care: 2011, 18(suppl.) 203. Abstract. 12th Congress of the European Association of Palliative Care: 'Palliative Care Reaching Out', 18-21 May 2011, Lisbon, Portugal.
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Research aims: Nowadays, palliative care is considered as a continuum from the diagnosis of a life-threatening illness until death. Aim of this study was to test the assumption of a decreasing importance of curative or life-prolonging treatments and increasing importance of palliative treatment towards death. Study design and methods: Data were acquired from a Dutch nationally representative surveillance network of sentinel general practitioners. GPs filled in a 21-item registration form for all of their patients who died non-suddenly in 2009. GPs were asked retrospectively whether cure, life prolongation and comfort/palliation were important treatment aims. This was measured on a 5-point scale ranging from ‘not at all important’ to ‘very important’. This was asked for three time periods: months 2 and 3 before death, 2nd to 4thweek before death and last week before death. Result: The data concerned 279 patients who died non-suddenly at home or in a residential care home. 55% had cancer and 45% were non-cancer patients. 50% of the patients were aged between 65 and 84 years. In all patients and all periods distinguished, the % of patients in which the palliative treatment aim was (very) important increased to death. GPs considered the palliative treatment aim (very) important in 73% of all patients in months 2 and 3 before death, while this was the case in 89% in the 2nd to 4thweek and in 95% in the last week before death. However, in 7% of these patients who all died nonsuddenly, cure was still considered a (very) important treatment aim in the last week of life. In 9% of the patients life prolongation was considered a (very) important treatment aim. Conclusion: Palliation is important in an increasing number of patients when death nears. Though cure and life-prolongation are in some patients with a foreseen death still (very) important treatment aims, even in the last week of life. (aut. ref.)