title: Palliative care service use in four European countries: a cross-national retrospective study via representative networks of general practitioners.
abstract: BACKGROUND
  Due to a rising number of deaths from cancer and other chronic diseases a growing number of people experience complex symptoms and require palliative care towards the end of life. However, population-based data on the number of people receiving palliative care in Europe are scarce. The objective of this study is to examine, in four European countries, the number of people receiving palliative care in the last three months of life and the factors associated with receiving palliative care.
  
  
  METHODS
  Cross-national retrospective study. Over two years (2009-2010), GPs belonging to representative epidemiological surveillance networks in Belgium, the Netherlands, Italy, and Spain registered weekly all deaths of patients (≥ 18 years) in their practices and the care they received in the last three months of life using a standardized form. Sudden deaths were excluded.
  
  
  RESULTS
  We studied 4,466 deaths. GPs perceived to have delivered palliative care to 50% of patients in Belgium, 55% in Italy, 62% in the Netherlands, and 65% in Spain (p<.001). Palliative care specialists attended to 29% of patients in the Netherlands, 39% in Italy, 45% in Spain, and 47% in Belgium (p<.001). Specialist palliative care lasted a median (inter-quartile range) of 15 (23) days in Belgium to 30 (70) days in Italy (p<.001). Cancer patients were more likely than non-cancer patients to receive palliative care in all countries as were younger patients in Italy and Spain with regard to specialist palliative care.
  
  
  CONCLUSIONS
  Although palliative care is established in the countries studied, there are considerable differences in its provision. Two potentially underserved groups emerge non-cancer patients in all countries and older people in Italy and Spain. Future research should examine how differences in palliative care use relate to both patient characteristics and existing national health care policies.
authors.affiliation: End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.
authors.forename: Lara
authors.initials: L
authors.lastname: Pivodic
authors.affiliation: End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.
authors.forename: Koen
authors.initials: K
authors.lastname: Pardon
authors.affiliation: End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.
authors.forename: Lieve
authors.initials: L
authors.lastname: Van den Block
authors.affiliation: Scientific Institute of Public Health (Wetenschappelijk Instituut Volksgezondheid, Institut Scientifique de Santé Publique), Unit of Health Services Research, Brussels, Belgium.
authors.forename: Viviane
authors.initials: V
authors.lastname: Van Casteren
authors.affiliation: Clinical and Descriptive Epidemiology Unit, Cancer Prevention and Research Institute, Florence, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Miccinesi
authors.affiliation: Dutch Sentinel General Practice Network, NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
authors.forename: Gé A
authors.initials: GA
authors.lastname: Donker
authors.affiliation: Public Health General Directorate, Regional Ministry of Health (Dirección General de Salud Pública, Consejería de Sanidad), Castile and Leon, Valladolid, Spain.
authors.forename: Tomás Vega
authors.initials: TV
authors.lastname: Alonso
authors.affiliation: Public Health General Directorate, Regional Ministry of Health (Dirección General de Salud Pública, Consejería de Sanidad), Castile and Leon, Valladolid, Spain.
authors.forename: José Lozano
authors.initials: JL
authors.lastname: Alonso
authors.affiliation: Italian Society of General Medicine (Società Italiana di Medicina Generale), Florence, Italy.
authors.forename: Pierangelo Lora
authors.initials: PL
authors.lastname: Aprile
authors.affiliation: Department of Public and Occupational Health, EMGO+ Institute, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Bregje D
authors.initials: BD
authors.lastname: Onwuteaka-Philipsen
authors.affiliation: End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium ; Department of Public and Occupational Health, EMGO+ Institute, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Luc
authors.initials: L
authors.lastname: Deliens
mesh_terms: D000367:Age Factors; D003695:Delivery of Health Care; D005060:Europe; D005260:Female; D058005:General Practitioners; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000401:mortality / Q000628:therapy*; D010166:Palliative Care; D012189:Retrospective Studies