End‐of‐life care of nursing home residents: A survey among general practitioners in northwestern Germany

Abstract

AimTo describe general practitioners' (GPs) perspectives on end‐of‐life care of nursing home residents.MethodsWe carried out a cross‐sectional study. A questionnaire was sent to a random sample of 1121 GPs in the German federal states of Bremen and Lower Saxony in 2018. Data were compared between GPs with a qualification in palliative medicine and those without such qualifications, and multivariable logistic regression was performed.ResultsOverall, 375 questionnaires were returned (response rate 34%). The majority of GPs (71%) agreed that nursing home residents are treated too often in hospitals at the end of life, and more than half rated end‐of‐life care in nursing homes as “rather poor” (54%). For both questions, GPs with a qualification in palliative medicine showed higher agreements. In the multivariable analysis, a prior qualification in palliative medicine was also strongly associated with rating end‐of‐life care as “rather poor” (OR 1.89, 95% CI 1.10–3.23). Respondents cited higher staffing ratios and better trained nursing staff as the most important measures to improve end‐of‐life care. Furthermore, it was estimated that just 37% of residents have an advance directive, with only one‐third including valid information on end‐of‐life hospitalizations.ConclusionsThis study showed that GPs tend to be critical regarding end‐of‐life care in nursing homes. To improve end‐of‐life care, better training in palliative care for nursing staff and GPs might be warranted. In addition, advance care planning can help to ensure that residents' wishes are respected. Geriatr Gerontol Int 2020; 20: 25–30.

Ultrasonography in assessing suspected bone fractures: a cross-sectional survey amongst German general practitioners

“…The response rate achieved in our study was relatively high compared to similar recently published surveys among German GPs [21][22][23][24] and acceptable considering international findings [25].…”

Ultrasonography in assessing suspected bone fractures: a cross-sectional survey amongst German general practitioners

“…The response rate achieved in our study was relatively high compared to similar recently published surveys among German GPs [21][22][23][24] and acceptable considering international findings [25]. Nonetheless, it was lower than 50%, and bias due to an overrepresentation of those GPs interested in the topic cannot be excluded.…”

How Do German General Practitioners Assess Medical Specialist Care Needs of Nursing Home Residents? Results of a Postal Survey in North-Western Germany

“…The uncoordinated involvement of different specialties for one patient might lead to a number of problems including differences in therapeutic goals and polypharmacy [ 34 ]. End-of-life situations are examples in which GPs intentionally reduce the involvement of medical specialists for patients from nursing homes in favor of palliative approaches as the reduction of interventions and de-escalation of therapies [ 26 ].…”

“…To increase response to the postal survey several strategies shown by a Cochrane review were applied [ 25 ] including a short questionnaire, pre-paid return envelopes, and a follow-up contact. This questionnaire was part of the “HOspitalizations and eMERgency department visits of Nursing home residents” (HOMERN) project to assess frequencies and reasons for hospital transfers of nursing home residents [ 26 ].…”

“…Equally, palliative medicine is provided by GPs or other specialists (i.e., anesthesiologists) with a sub-specialization, we therefore did not treat palliative medicine as a separate specialization from GPs. Furthermore, GPs views on end-of-life and palliative care in nursing homes are published elsewhere [ 26 ]. Finally, we asked respondents to state the degree of agreement with the following statements: whether the residency was considered as a sufficient qualification for providing medical care for nursing homes residents and whether the quality of care might be better when only one GP practice provided care for all nursing homes residents in one nursing home.…”