Life-limiting chronic progressive malignant and non-malignant diseases no limitation on certain lchronic diseases/conditions
Conditions
Interventions
Group 1: (1) Bereaved relatives (n=30) of deceased older patients of the involved general practices:
After death interviews concerning their perception of the illness trajectory and general practitio
(bb) structured questionnaire concerning practice organisation and clinical practice in end of life care (German version of the General Practice End-of-Life Care Index (GP-EoLC-I) [1]) (t0 vs t1).
c.
Sponsors
Medizinische Hochschule Hannover
Eligibility
Sex/Gender
All
Age
70 Years to No maximum
Inclusion criteria
Inclusion criteria: (1) Remained relatives of patients deceased in the observation period of the involved general practices: Age > 18, close associate and in direct contact with deceased patient in the last phase of life, (independent of sex) (2) Deceased patients of targeted general practices: Age: > 70 (independent of sex) Diagnosed life-limiting, chronic oncological and non-oncological disease(s) and at least two indicators of the Supportive and Palliative Care Indicators Tools (SPICT) applied [https://www.spict.org.uk/]; deceased within the 6 month observation period pre or post intervention respectively. (3) Health Professionals a. Key representatives/stakeholder in the regional for older patients: Owing their position/being employed at for least 1year in the institution (e.g., community nursing agency, nursing home, hospice) (independent of sex) b. General Practitioners: Registered in the region and at least one year of professional experiences in the respective general practice (independent of sex) c. Practice assistants: Employed in the general practice at for least 1 year (independent of sex)
Exclusion criteria
Exclusion criteria: (1) Bereaved relatives of deceased older patients of the targeted general practices: Sudden death of the deceased patient, not related to a life-limiting chronic disease (e.g. traffic accident, heart attack without diagnosis of coronary heart disease), complicated grief and/or mental illness (2) Deceased older patents of the general practices: Sudden death, not related to a life-limiting chronic disease (e.g. traffic accident, heart attack without diagnosis of coronary heart disease)
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Improved general practitioner’s care for older patients with life-limiting chronic disease in the last phase of life a. from the bereaved relatives perspective measured by an index of general practitioners end of life care, which is part of the supplementary structured questionnaire of the after death interviews (short version of the EPACS – Establishment of Hospice and Palliative Care Services Questionnaire) [1]; captured dimensions are communication and information, involvement in therapeutical decisions (shared decision) making, consideration of therapeutic preferences, Advanced-Care-Planning, psychosocial support, care continuity of care and availability. b. on the level of general care practices selected clinical routine data used in the Bertelsmann Faktencheck [2] to determine the quality of palliative care, namely the provision of general palliative care (AAPV), the prescription of specialist palliative care (SAPV), and the onset of AAPV and SAPV. a/b. Survey period: t=0 six month pre interventionem, t=1 six month post interventionem [1] Escobar Pinzón LC et al. End-of-life care in Germany: Study design, methods and first results of the EPACS study (Establishment of Hospice and PC Services in Germany). BMC Palliat Care. 2010; 9: 16. [2] Radbruch L et al. Überversorgung kurativ – Unterversorgung palliativ? Faktencheck Palliativversorgung Modul 3. Gütersloh: Bertelsmann Stiftung, 2015 | — |
Secondary
| Measure | Time frame |
|---|---|
| c. Improved care the end-of-life– Analysis of clinical routine data of the general practices Seclected palliative care quality indicators of the Faktenchecks of the Bertelsmann Stiftung 2015 [1]: t0 6 month pre interventionem, t1 6 month post interventionem: - Number of unplanned hospital admissions of deceased older patients life in the last 6 months of their life - Number/proportion of hospital deaths of older patients with life limiting chronic diseases - congruence of preferred and actual place of death d. Improved practice organisation and clinical practice according to the general practitioners’ view: t0 6 month pre interventionem, t1 6 month post interventionem): structured questionnaire with the german Version of the End-of-life Care-Index (EoLC-I) [2]. e. Usage of the decision aid and care pathway: Pseudonymised documentation by the participating practice teams: Number and characteristics of older patients with life limiting diseases, for which the decision aid and care pathway was used to support the identification of palliative situation during the intervention phase. d. Effectiveness – practical consequences of the intervention concept: Pseudonymised documentation by the participating practice teams: Interventions initiated for patients eligible for palliative care according to the decision aid within 6 months (e.g., advanced-care planning, medication review, initiating of specialist palliative care). [1] Radbruch L et al. Überversorgung kurativ – Unterversorgung palliativ? Faktencheck Palliativversorgung Modul 3. Gütersloh: Bertelsmann Stiftung, 2015. [2] Hughes PM et al. What progress has been made towards implementing national guidance on end of life care? A national survey of UK general practices. Palliat Med 2010;24:68-78. | — |
Countries
Germany
Contacts
Public ContactGabriele Müller-Mundt
Medizinische Hochschule HannoverInstitut für Allgemeinmedizin OE 5440
Outcome results
None listed