END-OF-LIFE CARE IN A PHYSICIAN

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END-OF-LIFE CARE IN A PHYSICIANS WORK IN FINNISH
HEALTH CENTRES

• Kosunen E, Hautala K, Fält A, Hinkka H, Lammi UK,
  Kellokumpu-Lehtinen P.
• Medical School
• University of Tampere
• Finland

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Background

• Even if age-adjusted incidende of cancer diseases
  remained the same, the total number of cancer
  patients will increase in the future years in
  Finland
• large age cohorts get old, people live longer,
  high survival rates (among the best in Europe)
• a part of the growing work load will be
  transferred to primary health care, including
  end-of-life (EOL) care

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Background

• End-of-life (EOL) care in Finland
• hospices only in the biggest cities
• secondary care hospitals
• regional hospitals
• central hospitals
• university hospitals
• primary care
• hospitals
• home care

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Aims of the study

• To study general practitioners (GPs) involvement
  in cancer patients EOL care in Finnish health
  centres
• To study GPs experiences of EOL care
• To study GPs educational needs related to EOL
  care

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Data collection

• A questionnaire was sent by mail in April 2003
• The target group all health centre physicians in
  Pirkanmaa Hospital District
• One reminded by post
• One reminder by e-mail to the chief physicians of
  the health centres

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Material

• 319 questionnaires were sent
• 196 physicians responded
• 55 reported that they did not belong to the
  target group any more
• 141 had completed the questionnaire
• the response rate was 53 (after excluding
  pollution)

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Respondents background, (n141)
Gender Female 66
Age (years) lt40 30
40-49 41
50 29
Years since graduating lt10 21
10-19 38
20 39
Worked in this health center (years) lt5 34
Worked in this health center (years) 5 66
Specialist in GP no 32
trainee 22
yes 46
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Respondents involvement in cancer care (n141)

Cancer patients in follow-up (n) None 9
1-4 27
5-10 35
10 28

Starting new follow-ups per year None 6
1-4 61
5-10 22
10 10

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Involvement in end-of-life care

• 84 (n118) had ever treated EOL patients -
  mostly in primary care
• 17 (n24) had at least one EOL patient at the
  moment

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Collaboration with hospitals (secondary care)

• in general, GPs were satisfied with the
  collaboration (consultations, help in acute
  problems)
• transfer of information was most often considered
  as bad or very bad (46)
• Written information on finishing active
  treatments was often missing

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Emotional stress (among GPs who had participated
in EOL care, n118)

• 72 reported having experienced emotional stress
  when making ethical decisions in EOL care
• 12 much or very much
• no significant differences by background factors
• men more than women ! (n.s.)
• 33 reported that they had sometimes felt guilty
  because of EOL decisions
• Only 34 had a possibility for supervision

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Economic aspects in EOL care

• Influence of financial factors was asked
• related to
• treatment of pain (13)
• antiemetic treatment (15)
• specialist consultations (19)
• Influence of financial factors was reported most
  often related to hospice care (40)

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Need of education and training proportions of
the responses quite/very much (n118)
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Discussion

• Response rate was quite low
• The respondents were experienced GPs, specialists
  more often than on average
• Probably this means that EOL treatment in PHC is
  mostly in experienced hands

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Conclusions

• EOL care is not yet very usual in primary health
  care
• When trying to increase it, good collaboration
  with secondary care is crucial
• Supervision should be available

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Thanks for your attention!
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Statistics Statistics Statistics

Newest survival rates

Relative 1-year and 5-year survival rates for patients with malignant neoplasms followed up in 2003-2005. Only cancer sites with mean annual number of casesover 65 are included. In situ and borderline tumours are  not included.