Transfer of information on palliative home care during the out-of-hours period.

BACKGROUND: Continuity of end-of-life care for patients receiving palliative care is an important challenge for out-of-hours services in general practice. AIM: To investigate how frequent information is transferred on patients receiving palliative care from GPs to the out-of-hours services, to explore the perceptions of GP's on this information transfer and to study the relation between information transfer and the used GP information systems. METHODS: This is a mixed-method design study. The frequency of information transfer to the out-of-hours services was investigated by analyzing a regional out-of-hours database. Barriers and promoting factors for this transfer of information were investigated by using semi-structured interviews among a purposive sample of GPs from the same region. The relation between information transfer and the GP information system was investigated by a postal questionnaire in a national random selection of GPs. RESULTS: When a palliative patient contacted the out-of-hours service, for 20% of these patients, a transfer of information was available and only half of these transfers included an anticipating end-of-life plan. All interviewed GPs considered continuity of care for these patients as important. However, some doubted whether a transfer of information is relevant for the quality of care. There was no relation between the information transfer and the used GP information systems. CONCLUSION: For only a minority of patients receiving palliative care, a transfer of information including an anticipating management plan was present. There is a large variation in the opinions of GPs on how to organize continuity of end-of-life care.

The effects of a postgraduate course on opioid-prescribing patterns of general practitioners.

BACKGROUND: The objective of this study is to evaluate whether a single palliative cancer care workshop, which included information about drug prescribing, had an effect on the opioid-prescription patterns of general practitioners in daily practice. METHOD: The opioid-prescription figures of 68 general practitioners who had participated in the workshop were aggregated from the computer system of the Regional Sick Fund. The prescription figures of a year before and a year after the workshop were compared and a control group of non-participants was included. RESULTS: This study showed a limited efficacy of a palliative cancer care workshop on the morphine-prescription figures of the general practitioners in daily practice. This limited effect did not accord with the results of a pre- and post-workshop questionnaire evaluating the attitudes of the same practitioners. CONCLUSION: A single workshop can not effectuate substantial changes in prescription behaviors. Possibilities for more reinforcements are discussed.

Learning effects of a workshop in palliative cancer care for general practitioners.

BACKGROUND: Cancer patients may unnecessarily suffer from pain and other symptoms due to insufficient knowledge on the part of their doctors. In The Netherlands, the general practitioner is considered to be the key provider of palliative care for the cancer patient. Therefore, the authors developed and conducted workshops to teach symptom control to general practitioners. These workshops contained learning objectives from which they selected 18 items to form a questionnaire with five-point response scales. The goal of this study was to investigate changes in the knowledge and attitude scores of the participating general practitioners. METHODS: The participants were asked to complete the questionnaire at the start of the workshop and also four months later. RESULTS: Responses were obtained from 120 general practitioners for the pre-workshop and 96 for the post-workshop questionnaires. The majority of the scores increased toward the desired effect, and some items' scores improved by almost two points. CONCLUSION: The results suggest improvements in general practitioners' knowledge and attitude scores with regard to cancer pain and symptom management. Future studies should try to link these improvements with quality-of-life parameters of terminal cancer patients and their families.

Symptoms and functional status of patients with disseminated cancer visiting outpatient departments.

Considerable research has focused on pain and other symptoms in terminal cancer patients referred to hospices and palliative care services. These patients differ from Dutch cancer patients in the palliative stage of their disease because the latter are cared for by general practitioners at home and medical specialists in outpatient departments. To clarify the experience of these Dutch patients, a study was started to investigate the prevalence and severity of pain and other symptoms as well as the functional status of consecutive patients visiting oncology outpatient departments for follow-up. After randomization, one group (I) of patients was interviewed at home by a general practitioner using structured questionnaires. The other group (II) received the questionnaires by mail, and scored the symptoms independently. The results of the symptom assessment show that patients in groups I and II suffered 2.4 (SD = 1.7) and 2.8 (SD = 2.0) symptoms, respectively. Between 30% and 40% of all patients reported constipation, nausea, loss of appetite, coughing, and dyspnea. These percentages were 50% lower when only moderate, severe, or extremely distressing symptoms were included. Sixty percent of all patients had pain, and 20% indicated a daytime pain score of 5 or greater on a scale of 0 to 10. Functional status was measured by the COOPWONCA charts; the mean score for the charts "physical fitness" and "daily activities" was 1.5 points lower for cancer patients than a random sample from the community of the same age and gender. The findings of this study should motivate doctors to put more energy in symptom assessment and interventions in palliative care.