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%)

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

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

Thanks for your attention!

Statistics

Newest survival

rates

Relative 1-year and 5-

year survival rates for

patients with malignant

neoplasms followed up

in 2003-2005. Only cancer sites with mean

annual number of

casesover 65 are included. In

situ and borderline

tumours are  not

included.