Discussing end-of-life issues in the last months of life: a nationwide study among general practitioners.
BACKGROUND
Communication is a necessary tool for ensuring the provision of quality patient-centered care for patients who have life-threatening illnesses, and discussing all relevant end-of-life issues should not be limited to cancer patients.


OBJECTIVE
To examine the incidence and timing of general practitioners (GPs) discussing end-of-life issues with patients whose deaths were expected, and to identify the factors associated with them discussing these issues.


METHODS
Between January and December 2008, GPs participating in a nationally representative sentinel surveillance network of GPs were asked to register, using standardised forms, the extent of discussing 10 end-of-life issues with patients.


RESULTS
We examined 252 patients who died nonsuddenly, 38% of whom died of cancer, and 86% of whose treatment goal was palliative care. Our findings show that GPs often waited until very close to death before they discussed end-of-life issues with patients, and discussed spiritual and social issues less than physical symptoms, diagnoses, and psychological problems. In 74% of cases, the GPs were informed of their patients' preferred place of death; and 8 out of 10 patients with known preferences for place of death, died there. Being diagnosed with cancer was associated with a higher frequency of discussing all 10 end-of-life issues than diagnosis with other (noncancer) conditions, but this is a state of mind we did not explore in this study.


CONCLUSIONS
Promotion of timely discussion of all relevant end-of-life issues, in patients with cancer and noncancer diagnoses, is advisable based on systematic needs assessment.
The EMGO Institute for Health & Care Research (EMGO+), Department of Public and Occupational Health, VU University Medical Center , Amsterdam, The Netherlands. ebun.abarshi@vumc.nl
Ebun
E
Abarshi
Michael
M
Echteld
Gé
G
Donker
Lieve
L
Van den Block
Bregje
B
Onwuteaka-Philipsen
Luc
L
Deliens
D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D003142:Communication; D005260:Female; D058005:General Practitioners; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009426:Netherlands; D010817:Physician-Patient Relations; D013727:Terminal Care