Yolanda Wh Penders1, Bregje Onwuteaka-Philipsen2, Sarah Moreels3, Gé A Donker4, Guido Miccinesi5, Tomás Vega Alonso6, Luc Deliens1,7, Lieve Van den Block1. 1. 1 End-of-Life Care Research Group, Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium. 2. 2 Amsterdam Public Health Research Institute, Department of Public and Occupational Health, Expertise Center for Palliative Care, VU University Medical Center, Amsterdam, The Netherlands. 3. 3 Scientific Institute of Public Health (Wetenschappelijk Instituut Volksgezondheid, Institut Scientifique de Santé Publique), Unit of Health Services Research, Brussels, Belgium. 4. 4 NIVEL Primary Care Database-Sentinel Practices, Netherlands Institute for Health Services Research, Utrecht, The Netherlands. 5. 5 Clinical and Descriptive Epidemiology Unit, Cancer Prevention and Research Institute, Florence, Italy. 6. 6 Public Health Directorate, Regional Ministry of Health (Dirección General de Salud Pública, Consellería de Sanidad), Valladolid, Spain. 7. 7 Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium.
Abstract
BACKGROUND: Measuring the quality of palliative care in a systematic way using quality indicators can illuminate differences between patient groups. AIM: To investigate differences in the quality of palliative care in primary care between people who died of cancer and people who died of organ failure. DESIGN: Mortality follow-back survey among general practitioners in Belgium, the Netherlands, and Spain (2013-2014), and Italy (2013-2015). A standardized registration form was used to construct quality indicators regarding regular pain measurement, acceptance of the approaching end of life, communication about disease-related topics with patient and next-of-kin; repeated multidisciplinary consultations; involvement of specialized palliative care; place of death; and bereavement counseling. SETTING/PARTICIPANTS: Patients (18+) who died non-suddenly of cancer, cardiovascular disease, or respiratory disease ( n = 2360). RESULTS: In all countries, people who died of cancer scored higher on the quality indicators than people who died of organ failure, particularly with regard to pain measurement (between 17 and 35 percentage-point difference in the different countries), the involvement of specialized palliative care (between 20 and 54 percentage points), and regular multidisciplinary meetings (between 12 and 24 percentage points). The differences between the patient groups varied by country, with Belgium showing most group differences (eight out of nine indicators) and Spain the fewest (two out of nine indicators). CONCLUSION: People who died of organ failure are at risk of receiving lower quality palliative care than people who died of cancer, but the differences vary per country. Initiatives to improve palliative care should have different priorities depending on the healthcare and cultural context.
BACKGROUND: Measuring the quality of palliative care in a systematic way using quality indicators can illuminate differences between patient groups. AIM: To investigate differences in the quality of palliative care in primary care between people who died of cancer and people who died of organ failure. DESIGN: Mortality follow-back survey among general practitioners in Belgium, the Netherlands, and Spain (2013-2014), and Italy (2013-2015). A standardized registration form was used to construct quality indicators regarding regular pain measurement, acceptance of the approaching end of life, communication about disease-related topics with patient and next-of-kin; repeated multidisciplinary consultations; involvement of specialized palliative care; place of death; and bereavement counseling. SETTING/PARTICIPANTS: Patients (18+) who died non-suddenly of cancer, cardiovascular disease, or respiratory disease ( n = 2360). RESULTS: In all countries, people who died of cancer scored higher on the quality indicators than people who died of organ failure, particularly with regard to pain measurement (between 17 and 35 percentage-point difference in the different countries), the involvement of specialized palliative care (between 20 and 54 percentage points), and regular multidisciplinary meetings (between 12 and 24 percentage points). The differences between the patient groups varied by country, with Belgium showing most group differences (eight out of nine indicators) and Spain the fewest (two out of nine indicators). CONCLUSION:People who died of organ failure are at risk of receiving lower quality palliative care than people who died of cancer, but the differences vary per country. Initiatives to improve palliative care should have different priorities depending on the healthcare and cultural context.
Entities:
Keywords:
Palliative care; cancer; organ failure; primary care; quality indicators
Authors: Joseph C Masdeu; Allen J Aksamit; Alan C Carver; Kathleen M Foley; Joseph S Kass; Raymond A Martin; Elizabeth A McCusker; Michael P McQuillen; Raja Mehanna; Richard Payne; Stephen J Victor; Steven Warach Journal: Neurology Date: 2019-09-17 Impact factor: 9.910
Authors: Kim de Nooijer; Lara Pivodic; Luc Deliens; Guido Miccinesi; Tomas Vega Alonso; Sarah Moreels; Lieve Van den Block Journal: BMJ Support Palliat Care Date: 2019-10-16 Impact factor: 3.568
Authors: Rose Miranda; Yolanda W H Penders; Tinne Smets; Luc Deliens; Guido Miccinesi; Tomás Vega Alonso; Sarah Moreels; Lieve Van den Block Journal: Age Ageing Date: 2018-11-01 Impact factor: 10.668