Coming home to go... : palliative care in general practice

In the Netherlands many patients with cancer die at home (60-70%). These patients are supported by their general practitioner (GP) in cooperation with informal caregivers and (often) nursing care. In the background information some concepts and characteristics of palliatieve medicine are explained, e.g. differences between primary and secondary care. A review and analysis is given of seven theses written by GPs about patients with cancer from 1918 until 2006. Sometimes the last phase of life is difficult , then the GP feels a need for support. In Groningen four GP advisors were appointed through the Comprehensive Cancer Centre North Netherlands who could be reached directly for telephone consultation. In our research the consultations (rising every year, in total 1385) and their evaluations were analyzed (2000-2003). GPs often asked for advice short before the death of the patient, physical symptoms formed the major part of the problems. In the evaluation the advices were judged as helpful and were carried out in 85% of the cases. A further analysis of the advices on nausea and vomiting and euthanasia and sedation is described. At the beginning of the project the need for ongoing education and support of GPs was investigated. Registration of new episodes of anxiety and depression entered by GPs in patients diagnosed with cancer was compared to a control group of patients without cancer. Registration of anxiety and depression on a symptom level was raised but there was no rise on a syndrome level. A majority of prescriptions was for medication to improve sleeping. Language: English