Interdisciplinary cooperation of GPs in palliative care at home: A nationwide survey in the Netherlands

Objective. To investigate the occurrence and predictors of interdisciplinary cooperation of GPs with other caregivers in palliative care at home. Design. In a prospective study among 96 general practices, the GPs involved identified all dying patients during the study period of 12 months. The GPs received an additional post-mortem questionnaire for each patient who died during the study period, and registered the healthcare providers with whom they cooperated. Multivariable logistic regression analysis was used to identify the predictors of GP cooperation with other caregivers. Setting. Second Dutch National Survey in General Practice. Subjects. A total of 743 patients who received palliative care according to their GP. Main outcome measures. Interdisciplinary cooperation between GP and other healthcare providers. Results. During the study period, 2194 patients died. GPs returned 1771 (73%) of the questionnaires. According to the GPs, 743 (46%) of their patients received palliative care. In 98% of these palliative care patients, the GP cooperated with at least one other caregiver, with a mean number of four. Cooperation with informal caregivers (83%) was most prevalent, followed by cooperation with other GPs (71%) and district nurses (63%). The best predictors of cooperation between GPs and other caregivers were the patient's age, the underlying disease, and the importance of psychosocial care. Conclusion. In palliative care patients, GP interdisciplinary cooperation with other caregivers is highly prevalent, especially with informal caregivers and other primary care collaborators. Cooperation is most prevalent in younger patients, patients with cancer as underlying disease, and if psychosocial care is important.

[1]  L. Deliens,et al.  Good end-of-life care according to patients and their GPs. , 2006, The British journal of general practice : the journal of the Royal College of General Practitioners.

[2]  A. Street,et al.  Communication issues for the interdisciplinary community palliative care team. , 2001, Journal of clinical nursing.

[3]  A. Edwards,et al.  Is there evidence that palliative care teams alter end-of-life experiences of patients and their caregivers? , 2003, Journal of pain and symptom management.

[4]  I. Higginson,et al.  Evaluation of a short-term group intervention for informal carers of patients attending a home palliative care service. , 2004, Journal of pain and symptom management.

[5]  B. Sibbald,et al.  Telephone versus postal surveys of general practitioners: methodological considerations. , 1994, The British journal of general practice : the journal of the Royal College of General Practitioners.

[6]  B. Wanrooij.  Palliatieve zorg vandaag en morgen , 2001, Huisarts en wetenschap.

[7]  C. Udén.  Studies on general practice out-of-hours care , 2005 .

[8]  J. Bensing,et al.  Monitoring health inequalities through general practice: the Second Dutch National Survey of General Practice. , 2005, European journal of public health.

[9]  M. Ribbe,et al.  Sterven met dementie: wat weten wij ervan? , 2007 .

[10]  G. van der Wal,et al.  The last 3 months of life: care, transitions and the place of death of older people. , 2005, Health & social care in the community.

[11]  S. Murray,et al.  General practitioners and their possible role in providing spiritual care: a qualitative study. , 2003, The British journal of general practice : the journal of the Royal College of General Practitioners.

[12]  R. Grol,et al.  General practitioners (GPs) and palliative care: perceived tasks and barriers in daily practice , 2005, Palliative medicine.

[13]  S. Murray,et al.  Out-of-hours palliative care: a qualitative study of cancer patients, carers and professionals. , 2006, The British journal of general practice : the journal of the Royal College of General Practitioners.

[14]  L. Deliens,et al.  Implementatie van niet-reanimeerbeleid op afdelingen acute geriatrie van Vlaamse ziekenhuizen in 2002 nog niet voltooid , 2007 .

[15]  L. W. Kates,et al.  Discussing religious and spiritual issues at the end of life: a practical guide for physicians. , 2002, JAMA.

[16]  D. Field.  Special not different: general practitioners' accounts of their care of dying people. , 1998, Social science & medicine.

[17]  H. T. ten Have,et al.  The concept of palliative care in the Netherlands , 2001, Palliative medicine.

[18]  Dena J. Schulman-Green.  Psychosocial issues in palliative care: Physicians’ self-perceived role and collaboration with hospital staff , 2003, The American journal of hospice & palliative care.

[19]  A. Ezzat,et al.  Book review: National cancer control programmes, policies and managerial guidelines. , 1996, Annals of Saudi medicine.

[20]  F. Elsner,et al.  Criteria for successful multiprofessional cooperation in palliative care teams , 2007, Palliative medicine.

[21]  S. Ristvedt,et al.  Patient care in multidisciplinary cancer clinics: Does attention to psychosocial needs predict patient satisfaction? , 2003, Psycho-oncology.

[22]  G. Crawford,et al.  Team working: palliative care as a model of interdisciplinary practice , 2003, The Medical journal of Australia.

[23]  E. Kosunen,et al.  Factors affecting physicians' decisions to forgo life-sustaining treatments in terminal care , 2002, Journal of medical ethics.

[24]  A. Cartwright.  Changes in life and care in the year before death 1969-1987. , 1991, Journal of public health medicine.

[25]  N. Christakis,et al.  Extent and determinants of error in doctors' prognoses in terminally ill patients: prospective cohort study , 2000, BMJ : British Medical Journal.

[26]  L. George.  Research design in end-of-life research: state of science. , 2002, The Gerontologist.

[27]  M. Ribbe,et al.  Een cultuurvergelijkend onderzoek naar behandelbesluiten van artsen met betrekking tot demente verpleeghuispatiënten met pneumonie , 2007 .

[28]  J. V. van Delden,et al.  End-of-life practices in the Netherlands under the Euthanasia Act. , 2007, The New England journal of medicine.

[29]  Eduardo Bruera,et al.  Impact of a half-day multidisciplinary symptom control and palliative care outpatient clinic in a comprehensive cancer center on recommendations, symptom intensity, and patient satisfaction: a retrospective descriptive study. , 2004, Journal of pain and symptom management.