title: Discussing end-of-life issues in nursing homes: a nationwide study in France.
abstract: discussing end-of-life issues with nursing home residents and their relatives is needed to ensure patient-centred care near the end of life.
  
  
  
  this study aimed to estimate the frequency of nursing home physicians discussing end-of-life issues with residents and their relatives and to investigate how discussing end-of-life issues was associated with care outcomes in the last month of life.
  
  
  
  post-mortem cohort study in a nationwide, representative sample of 78 nursing home facilities in France. Residents who died from non-sudden causes between 1 October 2013 and 31 May 2014 in these facilities were included (n = 674).
  
  
  
  end-of-life issues were discussed with at most 21.7% of the residents who died during the study period. In one-third of the situations (32.8%), no discussion about end-of-life-related topics ever occurred, either with the resident or with the relatives. Older people with severe dementia were less likely to have discussed more than three of the six end-of-life topics we investigated, compared with residents without dementia (OR = 0.17, 95% CI = 0.08-0.22). In the last month of life, discussing more than three end-of-life issues with the residents or their relatives was significantly associated with reduced odds of dying in a hospital facility (adjusted OR = 0.51, 95% CI = 0.33-0.79) and with a higher likelihood of withdrawing potentially futile life-prolonging treatments (adjusted OR = 2.37, 95% CI = 1.72-3.29).
  
  
  
  during the last months of life, discussions about end-of-life issues occurred with only a minority of nursing home decedents, although these discussions may improve end-of-life care outcomes.
authors.affiliation: Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden French National Observatory on End-of-Life Care, Paris, France.
authors.forename: Lucas
authors.initials: L
authors.lastname: Morin
authors.affiliation: Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
authors.forename: Kristina
authors.initials: K
authors.lastname: Johnell
authors.affiliation: VUB-UGent End-of-Life Care Research Group, Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium.
authors.forename: Lieve
authors.initials: L
authors.lastname: Van den Block
authors.affiliation: French National Observatory on End-of-Life Care, Paris, France Department of Palliative Care, University Hospital of Besancon, Besançon, France.
authors.forename: Régis
authors.initials: R
authors.lastname: Aubry
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003142:Communication; D003430:Cross-Sectional Studies; D003657:Decision Making; D005195:Family Relations; D005260:Female; D005602:France; D015577:Geriatric Assessment / Q000379:methods*; D006707:Homes for the Aged / Q000458:organization & administration*; D006801:Humans; D008134:Long-Term Care / Q000379:methods* / Q000523:psychology; D008297:Male; D009735:Nursing Homes / Q000458:organization & administration*; D010817:Physician-Patient Relations; D012307:Risk Factors; D013727:Terminal Care / Q000379:methods* / Q000523:psychology
keywords: communication; end-of-life care; long-term care; nursing home; older people