Does the GP make a difference

in palliative care?

Birgit Aabom

General practitioner, ph.d.

Rate of GP home visits (per month)

Adjustedodds ratio (95%CI)for dying in hospital(N=4386)

0 1.00

0.1 - 0.5 0.14 (0.09 to 0.21)

0.6 - 1 0.11 (0.07 to 0.17)

1-2 0.07 (0.05 to 1.00)

2-4 0.06 (0.04 to 0.08)

>4 0.05 (0.03 to 0.08)

Aabom B, Kragstrup J, Vondeling H, Bakketeig LS, Støvring H. Population-based study of place of death of patients with cancer: implications for GPs. Br J Gen Pract 2005; 55:684-9.

Tumor growth Treatment phasephase

Palliative / terminal fase

Clinical tumor 1. line Recidiv 2.-3.-4

GP GP

Hospital staff

Palliative team / Hospice

Death

GP

Region SYD

Interview study

“…they are good at that….. raising your spirits…….both the doctors and the nurses…. I would say you could use them as role models. They are incredibly careful and fantastic at keeping up ones spirit.” ( B12, 1. interview )

“…yes, they phone you and ask how you are feeling, tell you that your blood tests are OK. I have great respect for this. I think they do it very well…” ( B 1, 1. interview ) “When I come to the centre….. it is as if they have been waiting for me to come…” ( A 6, 1. interview )

Aabom B, Pfeiffer P. Why are some patients in treatment for advanced cancer reluctant to consult their GP? Scand J Prim Health Care 2009; 27: 58-62.

”..Not used my GP, he does not know the treatments I receive” ( Patient B4, 2. interview )

“My GP is not up-to-date” ( Patient B5, 1. interview )

“A lot of times I need to talk. Then I decide on my way to the hospital that I want to talk with one of the staff- it might be something physical or something psychological- but the problem is, that I share room with others, the room is filled with people and I don’t want to share my problems with the others in the ward, so I don’t say anything”

(Patient A6, 3. interview)

“But it is possible that the talk I miss with the hospital doctors that I could get that from my GP.

I could pay him a visit. Then he could discuss my case with the oncologist, take a few days to make himself acquainted with the situation, maybe go into details with the hospital doctors about specific questions I have.

He could then follow my case and support me, that` s some of the thoughts I have had.”

(Patient B1, 2. interview)

Yes, the GP makes a difference

GP home visit important for cancer patients

However, GP loosing contact to late-stage cancer

patients – (also) due to patient factors

Patients had increasing unmet psychosocial needs as

the disease progressed

Conclusion:

Table 8. Risk of dying in hospital in relation to GP home visits (+/- GP) among patients with and without a terminal declaration (+/- TD)

+ TD - TD

GP home visits per week

N OR (95%CI) Hospital death

%

N OR (95% CI) Hospital death

%

+ GP visit (0/1variable)

774 0.18 (0.11-0.29) 39 1251 0.08 (0.05-0.13) 66

0 160 1 78 591 1 92

0.1-0.19 153 0.28 (0.17-0.47) 77 178 0.14 (0.09-0.20) 89

0.2-0.39 116 0.11 (0.06-0.20) 48 211 0.14 (0.09-0.21) 51

0.4-0.59 155 0.08 (0.04-0.13) 30 142 0.07 (0.05-0.11) 34

0.6-1.49 155 0.09 (0.06-0.16) 26 109 0.09 (0.06-0.15) 43

≥1.5 31 0.07 (0.03-0.18) 12 20 0.10 (0.04-0.27) 40