end-of-life care in a physician’s work in finnish health centres kosunen e, hautala k, fält a,...
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END-OF-LIFE CARE IN A PHYSICIAN’S WORK IN FINNISH HEALTH CENTRES
Kosunen E, Hautala K, Fält A, Hinkka H, Lammi UK, Kellokumpu-Lehtinen P.
Medical SchoolUniversity of Tampere
Finland
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
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
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
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
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)
Respondents’ background, % (n=141)
Gender Female 66
Age (years) <40 30
40-49 41
50+ 29
Years since graduating <10 21
10-19 38
20 + 39
Worked in this health center (years)
<5 34
5+ 66
Specialist in GP no 32
trainee 22
yes 46
Respondents’ involvement in cancer care (n=141)
%
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
Involvement in end-of-life care
84 % (n=118) had ever treated EOL patients - mostly in primary care
17 % (n=24) had at least one EOL patient at the moment
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
Emotional stress (among GPs who had participated in EOL care, n=118)
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
Economic aspects in EOL care
Influence of financial factors was askedrelated to
treatment of pain (13%) antiemetic treatment (15%) specialist consultations (19%)
Influence of financial factors was reported most often related to hospice care (40%)
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
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