title: Home care by general practitioners for cancer patients in the last 3 months of life: An epidemiological study of quality and associated factors.
abstract: BACKGROUND
  Stronger generalist end-of-life care at home for people with cancer is called for but the quality of end-of-life care delivered by general practitioners has been questioned.
  
  
  OBJECTIVE
  To determine the degree of and factors associated with bereaved relatives' satisfaction with home end-of-life care delivered by general practitioners to cancer patients.
  
  
  METHODS
  Population-based mortality followback survey.
  
  
  METHODS
  Bereaved relatives of people who died of cancer in London, United Kingdom (identified from death registrations in 2009-2010), were invited to complete a postal questionnaire surveying the deceased's final 3 months of life.
  
  
  RESULTS
  Questionnaires were completed for 596 decedents of whom 548 spent at least 1 day at home in the last 3 months of life. Of the respondents, 55% (95% confidence interval: 51%-59%) reported excellent/very good home care by general practitioners, compared with 78% (95% confidence interval: 74%-82%) for specialist palliative care providers and 68% (95% confidence interval: 64%-73%) for district/community/private nurses. The odds of high satisfaction (excellent/very good) with end-of-life care by general practitioners doubled if general practitioners made three or more compared with one or no home visits in the patient's last 3 months of life (adjusted odds ratio: 2.54 (95% confidence interval: 1.52-4.24)) and halved if the patient died at hospital rather than at home (adjusted odds ratio: 0.55 (95% confidence interval: 0.31-0.998)).
  
  
  CONCLUSIONS
  There is considerable room for improvement in the satisfaction with home care provided by general practitioners to terminally ill cancer patients. Ensuring an adequate offer of home visits by general practitioners may help to achieve this goal.
authors.affiliation: Department of Family Medicine & Chronic Care, End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium lara.pivodic@vub.ac.be.
authors.forename: Lara
authors.initials: L
authors.lastname: Pivodic
authors.affiliation: Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Harding
authors.affiliation: Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK.
authors.forename: Natalia
authors.initials: N
authors.lastname: Calanzani
authors.affiliation: Institute of Psychiatry, King's College London, London, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: McCrone
authors.affiliation: Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK.
authors.forename: Sue
authors.initials: S
authors.lastname: Hall
authors.affiliation: Department of Family Medicine & Chronic Care, End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium.
authors.forename: Luc
authors.initials: L
authors.lastname: Deliens
authors.affiliation: Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK.
authors.forename: Irene J
authors.initials: IJ
authors.lastname: Higginson
authors.affiliation: Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK.
authors.forename: Barbara
authors.initials: B
authors.lastname: Gomes
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D058005:General Practitioners; D006699:Home Care Services / Q000592:standards; D006801:Humans; D008131:London; D008297:Male; D008875:Middle Aged; D009369:Neoplasms; D011787:Quality of Health Care; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000592:standards; D055815:Young Adult
keywords: Cancer; general practitioners; home care services; palliative care; satisfaction with care