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END-OF-LIFE CARE IN A PHYSICIAN’S WORK IN FINNISH HEALTH CENTRES

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 School University of Tampere Finland. Background.

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END-OF-LIFE CARE IN A PHYSICIAN’S WORK IN FINNISH HEALTH CENTRES

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  1. 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 School University of Tampere Finland

  2. 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

  3. 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

  4. 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

  5. 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

  6. 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)

  7. Respondents’ background, % (n=141)

  8. Respondents’ involvement in cancer care (n=141)

  9. 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

  10. 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

  11. 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 Emotional stress (among GPs who had participated in EOL care, n=118)

  12. Economic aspects in EOL care Influence of financial factors was asked related to • treatment of pain (13%) • antiemetic treatment (15%) • specialist consultations (19%) • Influence of financial factors was reported most often related to hospice care (40%)

  13. Need of education and training: proportions of the responses quite/very much (n=118)

  14. 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

  15. 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

  16. Thanks for your attention!

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