Palliative care in general practice for patients with cancer, organ failure and dementia or old-age: a cross-sectional study among general practitioners.

backgroundPalliative care enhances the quality of life of patients and their relatives facing a life-threatening illness or vulnerability. Initially, curative and life-prolonging treatments may be given alongside palliative care, but as the end of life approaches, palliative care becomes more prominent. Illness trajectories vary, and a distinction is made between the illness trajectories of cancer, organ failure and dementia or old age. This study compares end-of-life care for patients who died from cancer, organ failure and dementia or old age in the Netherlands, based on general practitioners’ reports.

methodsThis retrospective cross-sectional study used questionnaires completed by general practitioners within The Dutch Sentinel General Practice Network, a network designed and managed to be representative for the Dutch population (for age, sex and population density). Patients whose death was non-sudden between 1 January 2017 and 31 December 2019 were included. Outcomes include the importance of (curative, life-prolonging and palliative) treatment aims, palliative care provision, end-of-life discussions, and advance care planning. Differences in care between illness trajectory groups (patients with cancer, organ failure and dementia/old age) were analyzed using logistic regression analyses.

resultsIn the given period, general practitioners registered a total of 1364 deaths. Of these, 686 patients were included. These patients were under care of a general practitioner most of their last year of life and died non-suddenly from cancer (n = 435), organ failure (n = 128) or dementia/old-age (n = 123). As death approached, the importance of curative and life-prolonging treatment aims decreased, while importance of palliation increased, especially for patients with cancer. General practitioners provided palliative care more frequently to patients with cancer (89%) compared to those with organ failure (70%, OR 0.33) or dementia/old-age (79%, OR 0.26). End-of-life discussions were more common with patients with cancer, while one-third of patients with dementia/old age had no end-of-life discussions at all. General practitioners were more aware of the preferred place of death and end-of-life preferences of patients with cancer (92% and 76%), compared to patients with organ failure (81%, OR 0.38 and 56% OR 0.42) and dementia/old-age (87%, OR 0.38 and 50%, OR 0.25).

conclusionsThis study indicates that for patients with cancer, treatment is more often aimed at palliation, general practitioners more frequently provide palliative care, and end-of-life topics and advance care planning are discussed more often, compared to patients with organ failure or dementia/old-age. However, patients may have palliative care needs regardless of their illness or life expectancy. Therefore, it is important that palliative care is initiated early in the illness trajectory.