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Palliative Medicine, Vol. 20, No. 5, 507-512 (2006)
DOI: 10.1191/0269216306pm1169oa

Does persistent involvement by the GP improve palliative care at home for end-stage cancer patients?

Birgit Aabom

Jakob Kragstrup

Research Unit for General Practice, University of Southern Denmark, Odense

Hindrik Vondeling

Research Unit of Health Economics, University of Southern Denmark, Odense

Leiv S Bakketeig

Research Unit of Epidemiology, University of Southern Denmark, Odense

Henrik Stovring

Research Unit for General Practice, University of Southern Denmark, Odense

Objective: To analyse the effect of GP home visits on the granting of a terminal declaration (TD) and on place of death. Participants and design: A total of 2025 patients with cancer as the primary cause of death in the period 1997-1998, were investigated in a mortality follow-back design using the Danish Cancer Register and four administrative registers. The Danish TD can be issued by a physician for patients with an estimated prognosis of six months or less. The TD gives the right to economic benefits and increased care for the dying patient. Setting: The island of Funen/Denmark. Main outcome measures: Main outcome hospital death. Intermediate outcome TD. Results: A total of 38% of patients received a TD and 56% died in hospital. GP home visits in the week before TD (odds ratio (OR): 16.8; 95% CI: 8.2-34.4), as well as four weeks before TD (OR: 6.4; 95% CI: 4.5-9.2) were associated with an increased likelihood of receiving a TD. GP home visits in the group with TD (OR: 0.18; 95% CI: 0.11-0.29) and the group without TD (OR: 0.08; 95% CI: 0.05-0.13) was inversely associated with hospital death. A dose-response relationship was found in both groups. Conclusion: Persistent involvement by the GP is associated with improved end-of-life care for cancer patients. Provided that temporal relations are taken into account, the mortality follow-back design can be a suitable and ethical research method to highlight and monitor end-of-life cancer care.

Key Words: cancer • GP • mortality follow-back study • palliative care • place of death • population-based


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E. Michiels, R. Deschepper, G. Van Der Kelen, J. L. Bernheim, F. Mortier, R. Vander Stichele, and L. Deliens
The role of general practitioners in continuity of care at the end of life: a qualitative study of terminally ill patients and their next of kin
Palliative Medicine, July 1, 2007; 21(5): 409 - 415.
[Abstract] [PDF]