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Training general practitioners in early identification and anticipatory palliative care planning: A randomized controlled trial Clinical presentation, diagnosis, and management

Thoonsen, Bregje; Vissers, Kris C.; Verhagen, Stans; Prins, Judith; Bor, Hans; de Groot, Robert A.; Engels, Yvonne; van Weel, Chris

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Background: Most patients with advanced cancer, debilitating COPD or chronic heart failure (CHF) live at home. General practitioners (GPs) asked for guidance in how to recognize patients in need of palliative care in a timely way and to structure anticipatory care. For that reason, we developed a training for GPs in identifying patients in need of palliative care and in structuring anticipatory palliative care planning and studied its effect on out-of-hours contacts, contacts with their own GP,...[Show more]

dc.contributor.authorThoonsen, Bregje
dc.contributor.authorVissers, Kris C.
dc.contributor.authorVerhagen, Stans
dc.contributor.authorPrins, Judith
dc.contributor.authorBor, Hans
dc.contributor.authorde Groot, Robert A.
dc.contributor.authorEngels, Yvonne
dc.contributor.authorvan Weel, Chris
dc.date.accessioned2016-02-24T22:41:09Z
dc.identifier.issn1471-2296
dc.identifier.urihttp://hdl.handle.net/1885/98586
dc.description.abstractBackground: Most patients with advanced cancer, debilitating COPD or chronic heart failure (CHF) live at home. General practitioners (GPs) asked for guidance in how to recognize patients in need of palliative care in a timely way and to structure anticipatory care. For that reason, we developed a training for GPs in identifying patients in need of palliative care and in structuring anticipatory palliative care planning and studied its effect on out-of-hours contacts, contacts with their own GP, hospitalizations and place of death. Methods: We performed a cluster randomised controlled trial. GPs in the intervention group were trained in identifying patients in need of palliative care and anticipatory care planning. Next, for each identified patient, they were offered a coaching session with a specialist in palliative care to fine-tune a structured care plan. The GPs in the control group did not receive training or coaching, and were asked to provide care as usual. After one year, characteristics of patients deceased of cancer, COPD or CHF in both study groups were compared with mixed effects models for out-of-hours contacts (primary outcome), contacts with their own GP, place of death and hospitalizations in the last months of their life (secondary outcomes). As a post-hoc analysis, of identified patients (of the intervention GPs) these figures were compared to all other deceased patients, who had not been identified as in need of palliative care. Results: We did not find any differences between the intervention and control group. Yet, only half of the trained GPs (28) identified patients (52), which was only 24 % of the deceased patients. Those identified patients had significantly more contacts with their own GP (B 4.5218; p <0.0006), were less often hospitalized (OR 0.485; p 0.0437) more often died at home (OR 2.126; p 0.0572) and less often died in the hospital (OR 0.380; p 0.0449). Conclusions: Although we did not find differences between the intervention and control group, we found in a post-hoc analysis that those patients that had been identified as in need of palliative care had more contacts with their GP, less hospitalizations, and more often died at home. We recommend future controlled studies that try to further increase identification of patients eligible for anticipatory palliative care. The Netherlands National Trial Register: NTR2815 date 07-04-2010.
dc.publisherBioMed Central
dc.rightsAuthor/s retain copyright
dc.sourceBMC Family Practice Journal
dc.titleTraining general practitioners in early identification and anticipatory palliative care planning: A randomized controlled trial Clinical presentation, diagnosis, and management
dc.typeJournal article
local.description.notesImported from ARIES
local.identifier.citationvolume16
dc.date.issued2015
local.identifier.absfor111701 - Aboriginal and Torres Strait Islander Health
local.identifier.absfor111717 - Primary Health Care
local.identifier.absfor160104 - Social and Cultural Anthropology
local.identifier.ariespublicationU3488905xPUB6127
local.type.statusPublished Version
local.contributor.affiliationThoonsen, Bregje, Radboud University Nijmegen Medical Centre
local.contributor.affiliationVissers, Kris C., Radboud University Nijmegen Medical Centre
local.contributor.affiliationVerhagen, Stans, Radboud University Nijmegen Medical Centre
local.contributor.affiliationPrins, Judith, Radboud University Nijmegen Medical Centre
local.contributor.affiliationBor, Hans , Radboud University Nijmegen Medical Center
local.contributor.affiliationVan Weel, Chris, College of Medicine, Biology and Environment, ANU
local.contributor.affiliationde Groot, Robert A., Radboud University Nijmegen
local.contributor.affiliationEngels, Yvonne, Radboud University Nijmegen Medical Centre
local.bibliographicCitation.issue1
local.bibliographicCitation.startpage1
local.bibliographicCitation.lastpage12
local.identifier.doi10.1186/s12875-015-0342-6
dc.date.updated2016-02-24T10:09:53Z
local.identifier.scopusID2-s2.0-84942500731
dcterms.accessRightsOpen Access
CollectionsANU Research Publications

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