End-of-life communication: a retrospective survey of representative general practitioner networks in four countries.
BACKGROUND
Effective communication is central to high-quality end-of-life care.


OBJECTIVE
This study examined the prevalence of general practitioner (GP)-patient discussion of end-of-life topics (according to the GP) in Italy, Spain, Belgium, and The Netherlands and associated patient and care characteristics.


METHODS
This cross-sectional, retrospective survey was conducted with representative GP networks. Using a standardized form, GPs recorded the health and care characteristics in the last three months of life, and the discussion of 10 end-of-life topics, of all patients who died under their care. The mean number of topics discussed, the prevalence of discussion of each topic, and patient and care characteristics associated with discussions were estimated per country.


RESULTS
In total, 4396 nonsudden deaths were included. On average, more topics were discussed in The Netherlands (mean=6.37), followed by Belgium (4.45), Spain (3.32), and Italy (3.19). The topics most frequently discussed in all countries were "physical complaints" and the "primary diagnosis," whereas "spiritual and existential issues" were the least frequently discussed. Discussions were most prevalent in The Netherlands, followed by Belgium. The GPs from all countries tended to discuss fewer topics with older patients, noncancer patients, patients with dementia, patients for whom palliative care was not an important treatment aim, and patients for whom their GP had not provided palliative care.


CONCLUSIONS
The prevalence of end-of-life discussions varied across the four countries. In all countries, training priorities should include the identification and discussion of spiritual and social problems and early end-of-life discussions with older patients, those with cognitive decline if possible, and those with non-malignant diseases.
Department of Public and Occupational Health, EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: n.evans@vumc.nl.
Natalie
N
Evans
Regional Palliative Care Network, IRCCS AOU San Martino-IST, Genoa, Italy.
Massimo
M
Costantini
Department of Public and Occupational Health, EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands.
H R
HR
Pasman
End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel, Brussels, Belgium.
Lieve
L
Van den Block
Netherlands Institute of Health Services Research (NIVEL), Utrecht, The Netherlands.
Gé A
GA
Donker
Clinical and Descriptive Epidemiology Unit, ISPO Cancer Prevention and Research Institute, Florence, Italy.
Guido
G
Miccinesi
Italian Society of General Medicine, Florence, Italy.
Stefano
S
Bertolissi
Public Health Directorate, Ministry of Health, Castille and León, Spain.
Milagros
M
Gil
Scientific Institute of Public Health, Brussels, Belgium.
Nicole
N
Boffin
Public Health and Research General Directorate, Valencian Regional Health Administration, Valencia, Spain; Higher Public Health Research Centre, Valencia, Madrid, Spain; Spanish Consortium for Research on Epidemiology and Public Health, Madrid, Spain.
Oscar
O
Zurriaga
Department of Public and Occupational Health, EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands; End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel, Brussels, Belgium.
Luc
L
Deliens
Department of Public and Occupational Health, EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands.
Bregje
B
Onwuteaka-Philipsen
D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium; D003142:Communication; D003430:Cross-Sectional Studies; D005260:Female; D058005:General Practitioners / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010166:Palliative Care / Q000706:statistics & numerical data; D010817:Physician-Patient Relations; D012189:Retrospective Studies; D013030:Spain; D013727:Terminal Care / Q000706:statistics & numerical data*; D013732:Test Anxiety Scale
Patient-physician communication; cross-national; palliative care; patient participation; terminal illness