Meeting the Needs of Palliative Care Patients: General Practitioners' Survey on the Last Three Months of Life.

Abstract

Evaluating palliative care is challenging. Quality and efficiency indicators are not standardized, especially in primary care. To assess the adequacy of care to the patients' needs and associated factors, during the last three months of life, for palliative care patients followed up in general practice. A quantitative study based on a mortality follow-back survey of general practitioners (GPs), in metropolitan France. From November 2020 to November 2021, GPs included adult patients who died a predictable death. For each patient, they retrospectively rated how well the care provided met the patient's needs using a numerical scale. A generalized mixed model of logistic regression was used to examine associations between a positive evaluation and GP, patient, and care characteristics. Ninety-five GPs reported 295 patients. The median age was 85 years and 54% were women. The most common disease was cancer (41%) and 43% had dementia. Care assessment was mostly positive (76%). Cancer and hospitalization were negative factors (OR [95% CI] = 0.46 [0.25-0.86] and OR = 0.51 [0.26-0.98] respectively). Dementia, psychologist intervention and discussions with the family tended to be associated with positive evaluation but results were not significant due to a lack of statistical power (OR = 1.86 [0.98-3.52]; OR = 10.5 [2.12-51.8], OR = 2.74 [0.99-7.57] respectively). In end-of-life, GPs' evaluation of care adequacy to patient's needs was mostly positive. Indicators for palliative care evaluation, in a patient-centered approach, should consider inequalities due to medical conditions such as dementia and consider all the different possible care settings. Communication, psychosocial and spiritual approaches should be encouraged.