title: Training general practitioners in early identification and anticipatory palliative care planning: a randomized controlled trial.
abstract: BACKGROUND
  Most patients with advanced cancer, debilitating COPD or chronic heart failure (CHF) live at home. General practitioners (GPs) asked for guidance in how to recognize patients in need of palliative care in a timely way and to structure anticipatory care. For that reason, we developed a training for GPs in identifying patients in need of palliative care and in structuring anticipatory palliative care planning and studied its effect on out-of-hours contacts, contacts with their own GP, hospitalizations and place of death.
  
  
  METHODS
  We performed a cluster randomised controlled trial. GPs in the intervention group were trained in identifying patients in need of palliative care and anticipatory care planning. Next, for each identified patient, they were offered a coaching session with a specialist in palliative care to fine-tune a structured care plan. The GPs in the control group did not receive training or coaching, and were asked to provide care as usual. After one year, characteristics of patients deceased of cancer, COPD or CHF in both study groups were compared with mixed effects models for out-of-hours contacts (primary outcome), contacts with their own GP, place of death and hospitalizations in the last months of their life (secondary outcomes). As a post-hoc analysis, of identified patients (of the intervention GPs) these figures were compared to all other deceased patients, who had not been identified as in need of palliative care.
  
  
  RESULTS
  We did not find any differences between the intervention and control group. Yet, only half of the trained GPs (28) identified patients (52), which was only 24% of the deceased patients. Those identified patients had significantly more contacts with their own GP (B 4.5218; p <0.0006), were less often hospitalized (OR 0.485; p 0.0437) more often died at home (OR 2.126; p 0.0572) and less often died in the hospital (OR 0.380; p 0.0449).
  
  
  CONCLUSIONS
  Although we did not find differences between the intervention and control group, we found in a post-hoc analysis that those patients that had been identified as in need of palliative care had more contacts with their GP, less hospitalizations, and more often died at home. We recommend future controlled studies that try to further increase identification of patients eligible for anticipatory palliative care. The Netherlands National Trial Register: NTR2815 date 07-04-2010.
authors.affiliation: Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands. bregje.thoonsen@radboudumc.nl.
authors.forename: Bregje
authors.initials: B
authors.lastname: Thoonsen
authors.affiliation: Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands. kris.vissers@radboudumc.nl.
authors.forename: Kris
authors.initials: K
authors.lastname: Vissers
authors.affiliation: Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands. stans.verhagen@radboudumc.nl.
authors.forename: S
authors.initials: S
authors.lastname: Verhagen
authors.affiliation: Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands. judith.prins@radboudumc.nl.
authors.forename: J
authors.initials: J
authors.lastname: Prins
authors.affiliation: Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands. hans.bor@radboudumc.nl.
authors.forename: H
authors.initials: H
authors.lastname: Bor
authors.affiliation: Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands. chris.vanweel@radboudumc.nl.|Australian Primary Health Care Research Institute, Australian National University, Canberra, Australia. chris.vanweel@radboudumc.nl.
authors.forename: C
authors.initials: C
authors.lastname: van Weel
authors.affiliation: Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands. marieke.groot@radboudumc.nl.
authors.forename: M
authors.initials: M
authors.lastname: Groot
authors.affiliation: Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands. yvonne.engels@radboudumc.nl.
authors.forename: Y
authors.initials: Y
authors.lastname: Engels
mesh_terms: D016000:Cluster Analysis; D004502:Education, Medical, Continuing / Q000379:methods*; D005260:Female; D058005:General Practitioners / Q000193:education*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D009426:Netherlands; D010166:Palliative Care; D010347:Patient Care Planning; D012189:Retrospective Studies