Dying at home or in the hospital? An observational study in German general practice

Gágyor, Ildikó; Himmel, Wolfgang; Pierau, Andrea; Chenot, Jean‐François

doi:10.3109/13814788.2015.1117604

Cited by 16 publications

(11 citation statements)

References 31 publications

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“…[5][6][7][8][9] Recent reviews have highlighted how many studies reporting preferred place of death included high proportions of respondents with no recorded or stated preference regarding where they would like to die. 10 11 In light of the most prevalent place of death in many countries being hospital, [12][13][14][15][16] the UK hospice movement has responded with the development of 'hospice at home' (H@H) services. These provide more intensive nursing care in the home than is usually available 17 seeking to enable patients with advanced illness considered to be approaching the end of life, to be cared for and to die at home, if that is their preference.…”

Section: How This Fits Inmentioning

confidence: 99%

Persistent inequalities in Hospice at Home provision

Buck

Webb

Moth

et al. 2018

BMJ Support Palliat Care

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Section: How This Fits Inmentioning

confidence: 99%

Persistent inequalities in Hospice at Home provision

Buck

Webb

Moth

et al. 2018

BMJ Support Palliat Care

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“…The association between poor performance status and achieving preferred place of death may reflect unmeasured confounders; residential or nursing care have been shown to be less likely to transition into hospital near the end of life [24, 25]. We were unable to include information on place of residence in our model.…”

Section: Discussionmentioning

confidence: 99%

Understanding the factors associated with patients with dementia achieving their preferred place of death: a retrospective cohort study

et al. 2019

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Background dying in one’s preferred place is a quality marker for end-of-life care. Little is known about preferred place of death, or the factors associated with achieving this, for people with dementia. Aims to understand preferences for place of death among people with dementia; to identify factors associated with achieving these preferences. Population adults with a diagnosis of dementia who died between December 2015 and March 2017 and who were registered on Coordinate My Care, an Electronic Palliative Care Coordination System. Design retrospective cohort study. Analysis multivariable logistic regression investigated factors associated with achieving preferred place of death. Results we identified 1,047 people who died with dementia; information on preferred and actual place of death was available for 803. Preferred place of death was most commonly care home (58.8%, n = 472) or home (39.0%, n = 313). Overall 83.7% ( n = 672) died in their preferred place. Dying in the preferred place was more likely for those most functionally impaired (OR 1.82 95% CI 1.06–3.13), and with a ceiling of treatment of ‘symptomatic relief only’ (OR 2.65, 95% CI 1.37–5.14). It was less likely for people with a primary diagnosis of cancer (OR 0.52, 95% CI 0.28–0.97), those who were ‘for’ cardio-pulmonary resuscitation (OR 0.32, 95% CI 0.16–0.62) and those whose record was created longer before death (51–250 days (ref <50 days) OR 0.60, 95% CI 0.38–0.94). Conclusions most people with dementia want to die in a care home or at home. Achieving this is more likely where goals of treatment are symptomatic relief only, indicating the importance of advance care planning.

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“…The collection of clinical data is scheduled for six months before and six months after the intervention phase. Gágyor et al determined an average of 15 cases of death in each general practice per year (standard deviation 7.3, range 4.36) [36]. Consequently, a total of 500 cases of death in twelve months and respectively 250 cases of death in six months in 35 general practices are expected.…”

Section: Methods and Designmentioning

confidence: 99%

Optimal care at the end of life (OPAL): study protocol of a prospective interventional mixed-methods study with pretest-posttest-design in a primary health care setting considering the view of general practitioners, relatives of deceased patients and health care stakeholders

Afshar

Müller-Mundt

Baal

et al. 2019

BMC Health Serv Res

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Background At the end of life, about 85–90% of patients can be treated within primary palliative care (PC) provided by general practitioners (GPs). In Germany, there is no structured approach for the provision of PC by GPs including a systematic as well as timely identification of patients who might benefit from PC, yet. The project “Optimal care at the end of life” (OPAL) focusses on an improvement of primary PC for patients with both oncological and non-oncological chronic progressive diseases in their last phase of life provided by GPs and health care services. Methods OPAL will take place in Hameln-Pyrmont, a rural region in Lower Saxony, Germany. Target groups are (a) GPs, (b) relatives of deceased patients and (c) health care providers. The study follows a three-phase approach in a mixed-methods and pre-post design. In phase I (baseline, t 0 ) we explore the usual practice of providing PC for patients with chronic progressive diseases by GPs and the collaboration with other health care providers. In phase II (intervention) the Supportive and Palliative Care Indicators Tool (SPICT) for the timely identification of patients who might benefit from PC will be implemented and tested in general practices. Furthermore, a public campaign will be started to inform stakeholders, to connect health care providers and to train change agents. In phase III (follow-up, t 1 ) we investigate the potential effect of the intervention to evaluate differences in the provision of PC by GPs and to convey factors for the implementation of SPICT in general practices. Discussion The project OPAL is the first study to implement the SPICT-DE regionwide in general practices in Germany. The project OPAL may contribute to an overall optimisation of primary PC for patients in Germany by reducing GPs’ uncertainty in initiating PC, by consolidating their skills and competencies in identifying patients who might benefit from PC, and by improving the cooperation between GPs and different health care stakeholders. Trial registration The study was retrospectively registered at the German Clinical Trials Register (Deutsches Register Klinischer Studien; trial registration number: DRKS00015108 ; date of registration: 22th of January 2019).

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Dying at home or in the hospital? An observational study in German general practice

Abstract: Apart from patient-related factors such as comorbidity and health status, care by family members and GPs respectively, were determinants of dying at home.

Cited by 16 publications

References 31 publications

Persistent inequalities in Hospice at Home provision

Persistent inequalities in Hospice at Home provision

Understanding the factors associated with patients with dementia achieving their preferred place of death: a retrospective cohort study

Optimal care at the end of life (OPAL): study protocol of a prospective interventional mixed-methods study with pretest-posttest-design in a primary health care setting considering the view of general practitioners, relatives of deceased patients and health care stakeholders

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