TY - JOUR T1 - End-of-life communication: a retrospective survey of representative general practitioner networks in four countries. JF - J Pain Symptom Manage Y1 - 2014 A1 - Evans, Natalie A1 - Costantini, Massimo A1 - Pasman, H R A1 - Van den Block, Lieve A1 - Donker, Gé A A1 - Miccinesi, Guido A1 - Bertolissi, Stefano A1 - Gil Milagros A1 - Nicole Boffin A1 - Zurriaga, Oscar A1 - Deliens, Luc A1 - Onwuteaka-Philipsen, Bregje KW - Aged KW - Aged, 80 and over KW - Belgium KW - Communication KW - cross-sectional studies KW - Female KW - general practitioners KW - Humans KW - ITALY KW - Male KW - middle aged KW - Netherlands KW - Palliative Care KW - Physician-Patient Relations KW - Retrospective Studies KW - Spain KW - Terminal Care KW - Test Anxiety Scale AB -

CONTEXT: Effective communication is central to high-quality end-of-life care.

OBJECTIVES: This study examined the prevalence of general practitioner (GP)-patient discussion of end-of-life topics (according to the GP) in Italy, Spain, Belgium, and The Netherlands and associated patient and care characteristics.

METHODS: This cross-sectional, retrospective survey was conducted with representative GP networks. Using a standardized form, GPs recorded the health and care characteristics in the last three months of life, and the discussion of 10 end-of-life topics, of all patients who died under their care. The mean number of topics discussed, the prevalence of discussion of each topic, and patient and care characteristics associated with discussions were estimated per country.

RESULTS: In total, 4396 nonsudden deaths were included. On average, more topics were discussed in The Netherlands (mean=6.37), followed by Belgium (4.45), Spain (3.32), and Italy (3.19). The topics most frequently discussed in all countries were "physical complaints" and the "primary diagnosis," whereas "spiritual and existential issues" were the least frequently discussed. Discussions were most prevalent in The Netherlands, followed by Belgium. The GPs from all countries tended to discuss fewer topics with older patients, noncancer patients, patients with dementia, patients for whom palliative care was not an important treatment aim, and patients for whom their GP had not provided palliative care.

CONCLUSION: The prevalence of end-of-life discussions varied across the four countries. In all countries, training priorities should include the identification and discussion of spiritual and social problems and early end-of-life discussions with older patients, those with cognitive decline if possible, and those with non-malignant diseases.

VL - 47 CP - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23932176?dopt=Abstract M3 - 10.1016/j.jpainsymman.2013.04.008 ER -