title: The use of palliative care services associated with better dying circumstances. Results from an epidemiological population-based study in the brussels metropolitan region.
abstract: BACKGROUND
  There is some consensus that a "good death" is one which occurs at home, in the presence of loved ones, and is free of distress. Involvement of palliative care services is assumed to improve these circumstances.
  
  
  OBJECTIVE
  This population-based study describes characteristics of the end of life of patients dying in Brussels and examines their associations with the involvement of palliative care services.
  
  
  METHODS
  In 2007, an anonymous large-scale mortality follow-back survey was conducted in Brussels by mailing questionnaires regarding end-of-life care and characteristics to the attending physicians of a representative sample of 1961 deaths.
  
  
  RESULTS
  Response rate was 41% (n=701). Of all deaths, 59% were nonsudden. Of these, 12% took place at home. For 27%, the attending physician was informed about the patient's preferred place of death. When the preference to die at home was known, 66% died at home. At the moment of death, in 47% of nonsudden deaths, loved ones were present. In a quarter of deaths, palliative care services were involved. Involvement with palliative care services was more likely for cancer patients than noncancer patients and was associated with the attending physicians more often being informed about the preferred place of death, with patients more often dying at home, with loved ones more often being present, and with a better feeling of well-being on the last day.
  
  
  CONCLUSIONS
  Overall, circumstances at the very end of life are suboptimal in Brussels. This study provides a case for stronger involvement of palliative care as a focal point for policies to improve end-of-life circumstances in a metropolitan area such as Brussels.
authors.affiliation: End-of-Life Care Research Group, Ghent University and Vrije Universiteit Brussel, Brussels, Belgium. jcohen@vub.ac.be
authors.forename: Joachim
authors.initials: J
authors.lastname: Cohen
authors.forename: Dirk
authors.initials: D
authors.lastname: Houttekier
authors.forename: Kenneth
authors.initials: K
authors.lastname: Chambaere
authors.forename: Johan
authors.initials: J
authors.lastname: Bilsen
authors.forename: Luc
authors.initials: L
authors.lastname: Deliens
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium / Q000453:epidemiology; D002423:Cause of Death; D003643:Death; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D014505:Urban Population; D055815:Young Adult