title: Recognising patients who will die in the near future: a nationwide study via the Dutch Sentinel Network of GPs.
abstract: BACKGROUND
  Recognising patients who will die in the near future is important for adequate planning and provision of end-of-life care. GPs can play a key role in this.
  
  
  OBJECTIVE
  To explore the following questions: How long before death do GPs recognise patients likely to die in the near future? Which patient, illness, and care-related characteristics are related to such recognition? How does recognising death in the near future, before the last week of life, relate to care in during this period?
  
  
  METHODS
  One-year follow-back study via a surveillance GP network in the Netherlands.
  
  
  METHODS
  Registration of demographic and care-related characteristics.
  
  
  RESULTS
  Of 252 non-sudden deaths, 70% occurred in the home or care home and 30% in hospital. GP recognition of death in the near future was absent in 30%, and occurred prior to the last month in 15%, within the last month in 19%, and in the last week in 34%. Logistic regression analyses showed cancer and low functional status were positively associated with death in the near future; cancer and discussing palliative care options were positively associated with recognising death in the near future before the last week of life. Recognising death in the near future before patients' last week of life was associated with fewer hospital deaths, more GP-patient contacts in the last week, more deaths in a preferred place, and more-frequent GP-patient discussions about specific topics in the last 7 days of life.
  
  
  CONCLUSIONS
  Recognising death in the near future precedes several aspects of end-of-life care. The proportion in whom death in the near future is never recognised is large, suggesting GPs could be assisted in this process through training and implementation of care protocols that promote timely recognition of the dying phase.
authors.affiliation: The EMGO Institute for Health and Care Research, Department of Public and Occupational Health, VU University Medical Centre, Amsterdam, The Netherlands. ebun.abarshi@vumc.nl
authors.forename: Ebun A
authors.initials: EA
authors.lastname: Abarshi
authors.forename: Michael A
authors.initials: MA
authors.lastname: Echteld
authors.forename: Lieve
authors.initials: L
authors.lastname: Van den Block
authors.forename: Gé A
authors.initials: GA
authors.lastname: Donker
authors.forename: Luc
authors.initials: L
authors.lastname: Deliens
authors.forename: Bregje D
authors.initials: BD
authors.lastname: Onwuteaka-Philipsen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence / Q000592:standards*; D003657:Decision Making; D005194:Family Practice / Q000592:standards*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010819:Physician's Role; D018571:Sentinel Surveillance; D013727:Terminal Care / Q000592:standards*; D019452:Terminally Ill; D055815:Young Adult