title: Early identification of and proactive palliative care for patients in general practice, incentive and methods of a randomized controlled trial.
abstract: BACKGROUND
  According to the Word Health Organization, patients who can benefit from palliative care should be identified earlier to enable proactive palliative care. Up to now, this is not common practice and has hardly been addressed in scientific literature. Still, palliative care is limited to the terminal phase and restricted to patients with cancer. Therefore, we trained general practitioners (GPs) in identifying palliative patients in an earlier phase of their disease trajectory and in delivering structured proactive palliative care. The aim of our study is to determine if this training, in combination with consulting an expert in palliative care regarding each palliative patient's tailored care plan, can improve different aspects of the quality of the remaining life of patients with severe chronic diseases such as chronic obstructive pulmonary disease, congestive heart failure and cancer.
  
  
  METHODS
  A two-armed randomized controlled trial was performed. As outcome variables we studied: place of death, number of hospital admissions and number of GP out of hours contacts.
  
  
  CONCLUSIONS
  We expect that this study will increase the number of identified palliative care patients and improve different aspects of quality of palliative care. This is of importance to improve palliative care for patients with COPD, CHF and cancer and their informal caregivers, and to empower the GP. The study protocol is described and possible strengths and weaknesses and possible consequences have been outlined.
  
  
  BACKGROUND
  The Netherlands National Trial Register: NTR2815.
authors: Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre, P,O, Box 9101, 6500 HB Nijmegen, The Netherlands. B.Thoonsen@anes.umcn.nl
authors: Bregje
authors: B
authors: Thoonsen
authors: Marieke
authors: M
authors: Groot
authors: Yvonne
authors: Y
authors: Engels
authors: Judith
authors: J
authors: Prins
authors: Stans
authors: S
authors: Verhagen
authors: Cilia
authors: C
authors: Galesloot
authors: Chris
authors: C
authors: van Weel
authors: Kris
authors: K
authors: Vissers
mesh_terms: D017028:Caregivers / Q000523:psychology*; D005260:Female; D058006:General Practice; D058005:General Practitioners / Q000193:education* / Q000592:standards; D006333:Heart Failure / Q000523:psychology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology / Q000628:therapy; D009426:Netherlands; D010147:Pain Measurement / Q000379:methods / Q000592:standards; D010166:Palliative Care / Q000379:methods* / Q000458:organization & administration / Q000592:standards; D029424:Pulmonary Disease, Chronic Obstructive / Q000523:psychology / Q000628:therapy; D011788:Quality of Life; D012720:Severity of Illness Index; D019452:Terminally Ill / Q000523:psychology*; D013997:Time Factors