What are important treatment aims in the last three months of life?

Research aims: Nowadays, palliative care is considered as a continuum from the diagnosis of a life-threatening illness until death. Aim of this study was to test the assumption of a decreasing importance of curative or life-prolonging treatments and increasing importance of palliative treatment towards death. Study design and methods: Data were acquired from a Dutch nationally representative surveillance network of sentinel general practitioners. GPs filled in a 21-item registration form for all of their patients who died non-suddenly in 2009. GPs were asked retrospectively whether cure, life prolongation and comfort/palliation were important treatment aims. This was measured on a 5-point scale ranging from ‘not at all important’ to ‘very important’. This was asked for three time periods: months 2 and 3 before death, 2nd to 4thweek before death and last week before death. Result: The data concerned 279 patients who died non-suddenly at home or in a residential care home. 55% had cancer and 45% were non-cancer patients. 50% of the patients were aged between 65 and 84 years. In all patients and all periods distinguished, the % of patients in which the palliative treatment aim was (very) important increased to death. GPs considered the palliative treatment aim (very) important in 73% of all patients in months 2 and 3 before death, while this was the case in 89% in the 2nd to 4thweek and in 95% in the last week before death. However, in 7% of these patients who all died nonsuddenly, cure was still considered a (very) important treatment aim in the last week of life. In 9% of the patients life prolongation was considered a (very) important treatment aim. Conclusion: Palliation is important in an increasing number of patients when death nears. Though cure and life-prolongation are in some patients with a foreseen death still (very) important treatment aims, even in the last week of life. (aut. ref.