title: Identification of the palliative phase in people with dementia: a variety of opinions between healthcare professionals.
abstract: BACKGROUND
  People with dementia can benefit from a palliative care approach. Recommendations, such as those of the EAPC have been proposed to strengthen the provision of palliative care for this group of patients. Yet, it remains challenging for professionals to identify when a person with dementia is in need of palliative care. The objective of this study therefore was to explore when professionals in long-term care settings consider a person with dementia in need of palliative care.
  
  
  METHODS
  Teams with in total 84 professionals working in 13 long-term care settings from 6 countries (France, Germany, Italy, Norway, Poland and the Netherlands) received a case-vignette concerning a person with dementia recently admitted to a nursing home. Teams were asked to discuss when they considered people with dementia eligible for palliative care. The constant comparative method was used to analyse their answers.
  
  
  RESULTS
  Three different time points in the disease trajectory when people with dementia were considered to be eligible for palliative care were extracted: (1) early in the disease trajectory; (2) when signs and symptoms of advanced dementia are present; and (3) from the time point that curative treatment of co-morbidities is futile. Yet, none of these time points was uniformly considered by the professional teams across Europe. In some cases, professionals working in the same nursing home didn't even reach consensus when considering persons with dementia eligible for palliative care.
  
  
  CONCLUSIONS
  The results of the study identified that professionals across Europe have different opinions regarding the time point when to consider a person with dementia in need of palliative care.
authors.affiliation: Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands. Jasper.vanRietPaap@radboudumc.nl.
authors.forename: Jasper
authors.initials: J
authors.lastname: van Riet Paap
authors.affiliation: Department of Psychology, University of Bologna, Viale Berti Pichat 5, 40127, Bologna, Italy. elena.mariani6@unibo.it.
authors.forename: Elena
authors.initials: E
authors.lastname: Mariani
authors.affiliation: Department of Psychology, University of Bologna, Viale Berti Pichat 5, 40127, Bologna, Italy. rabih.chattat@unibo.it.
authors.forename: Rabih
authors.initials: R
authors.lastname: Chattat
authors.affiliation: Department of Primary and Community Care, Radboud university medical center, P.O. 6500 HB, Nijmegen, The Netherlands. Raymond.Koopmans@radboudumc.nl.|Radboud Alzheimer Centre, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands. Raymond.Koopmans@radboudumc.nl.|Joachim en Anna, Centre for specialized geraitric care, Nijmegen, The Netherlands. Raymond.Koopmans@radboudumc.nl.
authors.forename: Raymond
authors.initials: R
authors.lastname: Koopmans
authors.affiliation: Department of Geriatrics, Broca Hospital, AP-HP, 54-56 rue Pascal, 75013, Paris, France. helene.kerherve@brc.aphp.fr.
authors.forename: Hélène
authors.initials: H
authors.lastname: Kerhervé
authors.affiliation: Department of Palliative Medicine, Poznan University of Medical Sciences, 61-245, Poznan, Poland. wojciechleppert@wp.pl.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Leppert
authors.affiliation: Department of Palliative Medicine, Poznan University of Medical Sciences, 61-245, Poznan, Poland. mariaforycka@gmail.com.
authors.forename: Maria
authors.initials: M
authors.lastname: Forycka
authors.affiliation: Department of Palliative Medicine, Universitätsklinikum Bonn, Sigmund-Freud-Street 25, 53127, Bonn, Germany. Lukas.Radbruch@malteser.org.|Department of Palliative Care, Malteser Hospital Bonn /Rhein-Sieg, Bonn, Germany. Lukas.Radbruch@malteser.org.
authors.forename: Lukas
authors.initials: L
authors.lastname: Radbruch
authors.affiliation: Department of Palliative Medicine, Universitätsklinikum Bonn, Sigmund-Freud-Street 25, 53127, Bonn, Germany. Birgit.Jaspers@malteser.org.|Department of Palliative Care, Malteser Hospital Bonn /Rhein-Sieg, Bonn, Germany. Birgit.Jaspers@malteser.org.
authors.forename: Birgit
authors.initials: B
authors.lastname: Jaspers
authors.affiliation: Department of Anaesthesiology, Pain and Palliative Medicine, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands. Kris.Vissers@radboudumc.nl.
authors.forename: Kris
authors.initials: K
authors.lastname: Vissers
authors.affiliation: Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands. Myrra.Vernooij-Dassen@radboudumc.nl.|Radboud Alzheimer Centre, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands. Myrra.Vernooij-Dassen@radboudumc.nl.|Kalorama Foundation, Nijmegen, The Netherlands. Myrra.Vernooij-Dassen@radboudumc.nl.
authors.forename: Myrra
authors.initials: M
authors.lastname: Vernooij-Dassen
authors.affiliation: Department of Anaesthesiology, Pain and Palliative Medicine, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands. Yvonne.Engels@radboudumc.nl.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Engels
mesh_terms: D001291:Attitude of Health Personnel; D032921:Consensus; D003704:Dementia / Q000145:classification* / Q000628:therapy; D005060:Europe; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D008134:Long-Term Care / Q000379:methods*; D010166:Palliative Care; D005791:Patient Care / Q000145:classification*