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11 End of life: more quality and less suffering through better planning and coordination?

 

Most people want to spend the end of their life in circumstances that they have chosen and in a familiar environment. The study investigates whether proactive planning of treatment and nursing care and optimal coordination can prevent patients having to be admitted to hospital even if their condition deteriorates.

Portrait / project description (ongoing research project)

52 Swiss general practitioners will recruit a total of 260 adult patients with an average life expectancy of six months. The general practitioners will be assigned randomly to an intervention group and a control group. The doctors in the intervention group will be given systematic training and will treat their patients on the basis of a jointly developed care plan containing information about symptoms and patients’ decisions and on the organisation of nursing care and support for the family. The efficacy of the intervention will be determined using data from questionnaires about treatment quality and the satisfaction of patients and their families, as well as data on healthcare service utilisation and costs. Qualitative data will also be collected.

Background

At the end of life, patients and their families need answers to questions such as: “Will there be complications?” or “How much time is left?” Planning this last phase of life early on and in conjunction with general practitioners and domiciliary care services improves patients’ quality of life and the quality of the medical and nursing care they receive. Regrettably, this kind of planning takes place much too infrequently, leading to a situation in which high-cost medical treatments with questionable benefits are often given during the final days of life.

Aim

The aim of the study is to establish a model procedure in general practices and regional treatment and helper networks that will make proactive planning for the end of life a matter of course. The intention is to identify a good time to begin planning and to investigate how those affected deal with it, how confident general practitioners and domiciliary care providers feel in implementing this planning, and what impact planning and coordination have on quality and costs.

Relevance / Application

The study will provide evidence-based results concerning the impact of a care model designed to make more targeted use of acute medical services in the event of emergencies or complications. General practitioners will play a central role in the coordination of the palliative care network.

Original title

The Bern Primary Palliative Care Trial (Bern-PPCT): A cluster trial of palliative needs assessment and care in general practice

Project leaders

Applicant:

  • Prof. Dr. med. Steffen Eychmüller, MME, Universitäres Zentrum für Palliative Care, Inselspital, Universitätsspital Bern

Co-applicants:

  • Prof. Matthias Egger, Institut für Sozial- und Präventivmedizin, Universität Bern
  • Dr. Sven Streit, Berner Institut für Hausarztmedizin (BIHAM), Universität Bern

Project partners:

  • Dr. Corina Gross, Universität Bern
  • Dr. Heinrich Kläui, Verein Berner Haus- und Kinderärztinnen
  • Dr. Andreas Gerber, Spitex Bern
  • Dr. Sven Trelle, Clinical Trials Unit (CTU) Bern, Departement Klinische Forschung, Universität Bern
  • Dr. Christoph Cina, MediZentrum Messen AG, Messen
  • Prof. Geoffrey Mitchell, University of Queensland

 

 

Further information on this content

 Contact

Prof. Dr. med. Steffen Eychmüller Ärztlicher Leiter Universitäres Zentrum für Palliative Care INSELSPITAL, Universitätsspital Bern Dep. DOLS; SWAN Haus C 3010 Bern +41 31 632 51 07 steffen.eychmueller@insel.ch

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