Abstract
BackgroundDue to a rising number of deaths from cancer and other chronic diseases a growing number of people experience complex symptoms and require palliative care towards the end of life. However, population-based data on the number of people receiving palliative care in Europe are scarce. The objective of this study is to examine, in four European countries, the number of people receiving palliative care in the last three months of life and the factors associated with receiving palliative care.MethodsCross-national retrospective study. Over two years (2009–2010), GPs belonging to representative epidemiological surveillance networks in Belgium, the Netherlands, Italy, and Spain registered weekly all deaths of patients (≥18 years) in their practices and the care they received in the last three months of life using a standardized form. Sudden deaths were excluded.ResultsWe studied 4,466 deaths. GPs perceived to have delivered palliative care to 50% of patients in Belgium, 55% in Italy, 62% in the Netherlands, and 65% in Spain (p<.001). Palliative care specialists attended to 29% of patients in the Netherlands, 39% in Italy, 45% in Spain, and 47% in Belgium (p<.001). Specialist palliative care lasted a median (inter-quartile range) of 15 (23) days in Belgium to 30 (70) days in Italy (p<.001). Cancer patients were more likely than non-cancer patients to receive palliative care in all countries as were younger patients in Italy and Spain with regard to specialist palliative care.ConclusionsAlthough palliative care is established in the countries studied, there are considerable differences in its provision. Two potentially underserved groups emerge non-cancer patients in all countries and older people in Italy and Spain. Future research should examine how differences in palliative care use relate to both patient characteristics and existing national health care policies.
Highlights
It is estimated that, in Europe, 4.8 million people die every year
Given that a growing proportion of people will live into old and very old age, and that chronic diseases are more common in old people, an increasing number of people will be living with the effects of these illnesses [2,3]
People dying from cancer and other serious chronic diseases are very likely to experience multiple and complex symptoms requiring appropriate and timely assessment and treatment, and are in potential need of palliative care [2]
Summary
In Europe, 4.8 million people die every year. Approximately two million die from serious chronic disease and cancer, with a further increase in deaths from these causes expected [1]. Given that a growing proportion of people will live into old and very old age, and that chronic diseases are more common in old people, an increasing number of people will be living with the effects of these illnesses [2,3] The burden that these demographic and epidemiological developments place on society has been recognized by the World Health Organization (WHO) and the European Union who have identified care for people at the end of life as an important public health issue [4,5]. Little is known about the characteristics of people who do not receive palliative care, and about the extent to which palliative care is delivered to those dying from illnesses other than cancer, who are likely to be underserved [6,7]. The objective of this study is to examine, in four European countries, the number of people receiving palliative care in the last three months of life and the factors associated with receiving palliative care
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