title: Hospice assist at home: does the integration of hospice care in primary healthcare support patients to die in their preferred location - A retrospective cross-sectional evaluation study.
abstract: A majority of patients prefer to die at home. Specialist palliative care aims to improve quality of life. Hospice assist at home is a Dutch model of general/specialised palliative care within primary care, collaboratively built by general practitioners and a hospice.
  
  
  
  The aims of this study are to explore whether hospice assist at home service enables patients at hometo express end-of-life preferences and die in their preferred location. In addition, this study provides insight into symptomburden, stability and early referral.
  
  
  
  A retrospective cross-sectional evaluation study was performed (December 2014-March 2015), using hospice assist at home patient records and documentation. Primary outcome includes congruence between preferred and actual place of death. Secondary outcomes include symptom burden, (in)stability and early identification.
  
  
  
  Between June 2012 and December 2014, 130 hospice assist at home patients, living at home with a life expectancy <1 year, were enrolled. Hospice assist at home, a collaboration between general practitioners, district nurses, trained volunteers and a hospice team, facilitates (1) general practitioner-initiated consultation by Nurse Consultant Hospice, (2) fortnightly interdisciplinary consultations and (3) 24/7 hospice backup for patients, caregivers and professionals.
  
  
  
  A total of 130 patients (62 (48%) men; mean age, 72 years) were enrolled, of whom 107/130 (82%) died and 5 dropped out. Preferred place of death was known for 101/107 (94%) patients of whom 91% patients died at their preferred place of death.
  
  
  
  Hospice assist at home service supports patients to die in their preferred place of death. Shared responsibility of proactive care in primary care collaboration enabled patients to express preferences. Hospice care should focus on local teamwork, to contribute to shared responsibilities in providing optimal palliative care.
authors.affiliation: Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands Academic Hospice Demeter, De Bilt, The Netherlands e.degraaf@umcutrecht.nl.
authors.forename: Everlien
authors.initials: E
authors.lastname: de Graaf
authors.affiliation: Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Daniëlle
authors.initials: D
authors.lastname: Zweers
authors.affiliation: Academic Hospice Demeter, De Bilt, The Netherlands Community Health Center, De Bilt, The Netherlands.
authors.forename: Anna Ch
authors.initials: ACh
authors.lastname: Valkenburg
authors.affiliation: Academic Hospice Demeter, De Bilt, The Netherlands.
authors.forename: Allegonda
authors.initials: A
authors.lastname: Uyttewaal
authors.affiliation: Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands Academic Hospice Demeter, De Bilt, The Netherlands.
authors.forename: Saskia Ccm
authors.initials: SC
authors.lastname: Teunissen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006699:Home Care Services / Q000458:organization & administration*; D017051:Hospice Care / Q000458:organization & administration*; D064946:Hospice and Palliative Care Nursing / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010166:Palliative Care / Q000458:organization & administration*; D057240:Patient Preference; D011320:Primary Health Care / Q000458:organization & administration*; D011788:Quality of Life; D012189:Retrospective Studies; D012297:Right to Die
keywords: Palliative care; general practice; hospice care; patient preference; primary health care; service integration