Home care by general practitioners for cancer patients in the last 3 months of life: An epidemiological study of quality and associated factors

Abstract

Background: Stronger generalist end-of-life care at home for people with cancer is called for but the quality of end-of-life care delivered by general practitioners has been questioned.

Aim: To determine the degree of and factors associated with bereaved relatives' satisfaction with home end-of-life care delivered by general practitioners to cancer patients.

Design: Population-based mortality followback survey.

Setting/participants: Bereaved relatives of people who died of cancer in London, United Kingdom (identified from death registrations in 2009-2010), were invited to complete a postal questionnaire surveying the deceased's final 3 months of life.

Results: Questionnaires were completed for 596 decedents of whom 548 spent at least 1 day at home in the last 3 months of life. Of the respondents, 55% (95% confidence interval: 51%-59%) reported excellent/very good home care by general practitioners, compared with 78% (95% confidence interval: 74%-82%) for specialist palliative care providers and 68% (95% confidence interval: 64%-73%) for district/community/private nurses. The odds of high satisfaction (excellent/very good) with end-of-life care by general practitioners doubled if general practitioners made three or more compared with one or no home visits in the patient's last 3 months of life (adjusted odds ratio: 2.54 (95% confidence interval: 1.52-4.24)) and halved if the patient died at hospital rather than at home (adjusted odds ratio: 0.55 (95% confidence interval: 0.31-0.998)).

Conclusion: There is considerable room for improvement in the satisfaction with home care provided by general practitioners to terminally ill cancer patients. Ensuring an adequate offer of home visits by general practitioners may help to achieve this goal.

Keywords: Cancer; general practitioners; home care services; palliative care; satisfaction with care.

Figure 1.

Sampling and recruitment process. *Non-eligible deaths: deaths registered by a coroner, deceased under 18 years of age, cause of death non-cancer, place of death is NHS psychiatric hospital, non-NHS hospital, residential home or elsewhere/unspecified.

Figure 2.

Relatives’ satisfaction with the home care delivered in the last 3 months of patients’ life by GPs, specialist palliative care providers and district, community and private nurses. ^aData for patients who were not registered with a GP or not visited by a GP at home in the last 3 months of life or for whom this information was missing were excluded. ^bData for patients who were not visited at home by palliative care specialists in the last 3 months of life were excluded. ^cData for patients who were not visited by a district, community or private nurse in the last 3 months of life were excluded. Friedman test for differences in ratings between care providers only included cases for whom ratings for all three care provider groups were available (n = 245, 44.7%): χ²(2) = 65.82, p < 0.001. D/C/P: nurse, district/community/private nurse. Missing values: satisfaction with GP home care, n = 6 (1.6%); satisfaction with home care by palliative care specialists, n = 9 (2.6%); satisfaction with home care by district/community/private nurses, n = 2 (0.5%); satisfaction with home care overall, n = 13 (3.8%). Percentages are rounded and thus may not add up to 100.0.