Testing a structured End-of-Life care approach in Danish general practice settings.

Abstract

The Acute Basic Palliation Concept (ABPC) - a structured end-of-life (EoL) care model - increases quality of EoL care when used in hospital settings. To measure if the use of the ABPC could increase symptom relief and user satisfaction when applied in general practice. This cohort study was conducted across nine general practices in Northern Denmark with 29 GPs as well as in the regional Out of hours GP services. GPs received training in an adapted Acute Basic Palliation Concept (ABPC) and subsequently reported on patient cases managed both with and without the concept. Data on symptom control and satisfaction were collected via questionnaires from relatives, municipal caregivers, and GPs. A total of 74 EoL care trajectories were included in the analysis, with 51% managed using the structured concept. The mean patient age was 84 ± 8.9 years; 46% women. The median duration from EoL care initiation to death was 3.0 (interquartile range: 2.0;7.0) days. When using the concept, symptom control increased for pain (97% versus 83%), agitation (93% versus 56%), and discomfort (93% versus 81%), all <i>P</i><0.05. Shortness of breath was less frequent, with a trend toward improved symptom relief using the concept (81% vs. 54%). Most staff were willing to use the concept again (90% GPs, 100% municipal nurses). The structured ABPC model facilitated adequate symptom management and was widely accepted among general practitioners and municipal nurses, demonstrating promising potential for end-of-life care in a general practice setting.