Does persistent involvement by the GP improve palliative care at home for end-stage cancer patients?
OBJECTIVE
To analyse the effect of GP home visits on the granting of a terminal declaration (TD) and on place of death.


METHODS
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.


METHODS
The island of Funen/Denmark.


METHODS
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.


CONCLUSIONS
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.
Aabom
Birgit
B
Research Unit for General Practice, University of Southern Denmark, J.B. Winsloøws Vej 9A, 5000 Odense C, Denmark. baabom@health.sdu.dk
Kragstrup
Jakob
J
Vondeling
Hindrik
H
Bakketeig
Leiv S
LS
Stovring
Henrik
H
D000293:Adolescent; D000328:Adult; D000368:Aged; D001293:Attitude to Death; D003718:Denmark; D017050:Episode of Care; D005194:Family Practice / Q000458:organization & administration / Q000592:standards*; D005260:Female; D006699:Home Care Services; D006792:House Calls; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000451:nursing*; D016017:Odds Ratio; D010166:Palliative Care / Q000458:organization & administration / Q000592:standards*; D011787:Quality of Health Care; D013727:Terminal Care / Q000458:organization & administration / Q000592:standards*; D019452:Terminally Ill