Abstract
Background:
Stronger generalist end-of-life care at home for people with cancer is called for but the quality of end-of-life care delivered by general practitioners has been questioned.
Aim:
To determine the degree of and factors associated with bereaved relatives’ satisfaction with home end-of-life care delivered by general practitioners to cancer patients.
Design:
Population-based mortality followback survey.
Setting/participants:
Bereaved relatives of people who died of cancer in London, United Kingdom (identified from death registrations in 2009–2010), were invited to complete a postal questionnaire surveying the deceased’s final 3 months of life.
Results:
Questionnaires were completed for 596 decedents of whom 548 spent at least 1 day at home in the last 3 months of life. Of the respondents, 55% (95% confidence interval: 51%–59%) reported excellent/very good home care by general practitioners, compared with 78% (95% confidence interval: 74%–82%) for specialist palliative care providers and 68% (95% confidence interval: 64%–73%) for district/community/private nurses. The odds of high satisfaction (excellent/very good) with end-of-life care by general practitioners doubled if general practitioners made three or more compared with one or no home visits in the patient’s last 3 months of life (adjusted odds ratio: 2.54 (95% confidence interval: 1.52–4.24)) and halved if the patient died at hospital rather than at home (adjusted odds ratio: 0.55 (95% confidence interval: 0.31–0.998)).
Conclusion:
There is considerable room for improvement in the satisfaction with home care provided by general practitioners to terminally ill cancer patients. Ensuring an adequate offer of home visits by general practitioners may help to achieve this goal.
Stronger generalist end-of-life care at home for people with cancer is called for but the quality of end-of-life care delivered by general practitioners has been questioned.
Aim:
To determine the degree of and factors associated with bereaved relatives’ satisfaction with home end-of-life care delivered by general practitioners to cancer patients.
Design:
Population-based mortality followback survey.
Setting/participants:
Bereaved relatives of people who died of cancer in London, United Kingdom (identified from death registrations in 2009–2010), were invited to complete a postal questionnaire surveying the deceased’s final 3 months of life.
Results:
Questionnaires were completed for 596 decedents of whom 548 spent at least 1 day at home in the last 3 months of life. Of the respondents, 55% (95% confidence interval: 51%–59%) reported excellent/very good home care by general practitioners, compared with 78% (95% confidence interval: 74%–82%) for specialist palliative care providers and 68% (95% confidence interval: 64%–73%) for district/community/private nurses. The odds of high satisfaction (excellent/very good) with end-of-life care by general practitioners doubled if general practitioners made three or more compared with one or no home visits in the patient’s last 3 months of life (adjusted odds ratio: 2.54 (95% confidence interval: 1.52–4.24)) and halved if the patient died at hospital rather than at home (adjusted odds ratio: 0.55 (95% confidence interval: 0.31–0.998)).
Conclusion:
There is considerable room for improvement in the satisfaction with home care provided by general practitioners to terminally ill cancer patients. Ensuring an adequate offer of home visits by general practitioners may help to achieve this goal.
| Original language | English |
|---|---|
| Journal | Palliative Medicine |
| Volume | 30 |
| Issue number | 1 |
| Early online date | 2 Jun 2015 |
| DOIs | |
| Publication status | Published - 2016 |
Bibliographical note
AcknowledgmentsWe are particularly grateful to the people who, having recently lost a relative or friend to cancer, considered taking part in the study and to the funders of QUALYCARE – Cicely Saunders International – for their dedicated support, which made this study possible. We also thank the Department of Health and the four health districts (Primary Care Trusts) for their partnership in the study and the members of the project steering group and international advisors. A special thanks to the staff at the Office for National Statistics for their crucial help with sampling, mailings and datasets (Myer Glickman, Peter Davies, Justine Pooley and Stephen Rowland); Dr Jonathan Koffman for his help in setting up the study; Dr Gao Wei for her advice on sample size calculations and statistical issues; Dr Elizabeth Davies from the Thames Cancer Registry for her help in the ecological analysis to select the health districts; our local Cancer Research Network (South East London) for administrative support; Kerry Hylands for help with data entry; Sian Best for the development of the study website pages (http://www.csi.kcl.ac.uk/qualycare) and other members of the Cicely Saunders Institute. Lara Pivodic undertook this analysis as part of her work within the project EURO IMPACT, during a secondment at King’s College London, Cicely Saunders Institute. EURO IMPACT (European Intersectorial and Multidisciplinary Palliative Care Research Training) aims to develop a multidisciplinary, multi-professional and inter-sectorial educational and research training framework for palliative care research in Europe. In recognition of the collaborative nature of EURO IMPACT, we thank the following EURO IMPACT members: Van den Block Lieve1, De Groote Zeger1, Brearley Sarah2, Caraceni Augusto3,4, Cohen Joachim1, Francke Anneke5, Harding Richard6,7, Higginson Irene J6,7, Kaasa Stein8, Linden Karen9, Miccinesi Guido10, Onwuteaka-Philipsen Bregje5, Pardon Koen1, Pasman Roeline5, Pautex Sophie11, Payne Sheila2 and Deliens Luc1,5. EURO IMPACT is coordinated by Prof Luc Deliens and Prof Lieve Van den Block of the 1End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel (VUB), Brussels, Belgium. Other partners are as follows: 2International Observatory on End-of-Life Care, Lancaster University, Lancaster, UK; 3EAPC Research Network, Trondheim, Norway; 4Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; 5VU University Medical Center, EMGO Institute for Health and Care Research, Amsterdam, The Netherlands; 6King’s College London, Cicely Saunders Institute, London, UK; 7Cicely Saunders International, London, UK; 8Norwegian University of Science and Technology, Trondheim, Norway; 9Springer Science and Business Media, Houten, the Netherlands; 10Cancer Research and Prevention Institute, Florence, Italy; 11EUGMS European Union Geriatric Medicine Society, Geneva, Switzerland.
Funding
This work was supported by Cicely Saunders International. Lara Pivodic was funded to undertake this analysis as part of the EURO IMPACT project, supported by the European Union Seventh Framework Programme (FP7/2007-2013, under grant agreement no. 264697). Irene J Higginson is a UK NIHR (National Institute of Health Research) Senior Investigator.
