Advance care planning for patients with cancer in the palliative phase in Dutch general practices

被引:21
作者
Ermers, Daisy J. M. [1 ]
van Bussel, Karin J. H. [2 ]
Perry, Marieke [3 ]
Engels, Yvonne [1 ]
Schers, Henk J. [2 ]
机构
[1] Radboud Univ Nijmegen, Dept Anaesthesiol Pain & Palliat Med, Med Ctr, Nijmegen, Netherlands
[2] Radboud Univ Nijmegen, Dept Primary & Community Care, Med Ctr, POB 9101, NL-6500 HB Nijmegen, Netherlands
[3] Radboud Univ Nijmegen, Dept Geriatr, Med Ctr, Nijmegen, Netherlands
关键词
Advance care planning; continuity of patient care; general practice; hospitalization; palliative care; patient preference; END-OF-LIFE; MEDICAL-CARE; NEAR-DEATH; CONTINUITY; ASSOCIATIONS; OUTCOMES; HEALTH; TRUST;
D O I
10.1093/fampra/cmy124
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Background. Advance care planning (ACP) is a crucial element of palliative care. It improves the quality of end-of-life care and reduces aggressive and needless life-prolonging medical interventions. However, little is known about its application in daily practice. This study aims to examine the application of ACP for patients with cancer in general practice. Methods. We performed a retrospective cohort study in 11 general practices in the Netherlands. Electronic patient records (EPRs) of deceased patients with colorectal or lung cancer were analysed. Data on ACP documentation, correspondence between medical specialist and GP, and health care use in the last year of life were extracted. Results. Records of 163 deceased patients were analysed. In 74% of the records, one or more ACP items were registered. GPs especially documented patients' preferences for euthanasia (58%), palliative sedation (46%) and preferred place of death (26%). Per patient, GPs received on average six letters from medical specialists. These letters mainly contained information regarding medical treatment and rarely ACP items. In the last year of life, patients contacted the GP over 30 times, and 51% visited the emergency department at least once, of whom 54% in the last month. Conclusions. Registration of ACP items in GPs' EPRs appeared to be limited. ACP elements were rarely subject of communication between primary and secondary care, which may impact the continuity of patient care during the last year of life. More emphasis on registration of ACP items and better exchange of information regarding patients' preferences are needed.
引用
收藏
页码:587 / 593
页数:7
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