Physician involvement and recognition of the resident's last phase of life in long-term care facilities: Findings from an EU FP7 funded cross-sectional study in 6 European countries (PACE)

Research aims: Ensuring the delivery of prompt, comprehensive palliative care in long-term care facilities (LTCFs) requires a multidisciplinary approach, including involvement of the physician. This study aims to describe and compare among 6 European countries (1) to what extent physicians are involved in the care of residents living in LTCFs; (2) to what extent physicians recognize the resident's last phase of life and; (3) how (1) and (2) are associated. Study population: 1094 deceased residents of 239 LTCFs, about whom 505 physicians in Belgium (BE), Finland (FI), Poland (PL), Italy (IT), The Netherlands (NL) and England (EN) reported on the number of visits they paid to the resident, treatment goals, whether they recognized a resident's terminal illness and whether they expected death. Study design and methods: In each country, a cross-sectional study was conducted within representative samples of LTCFs. Participating LTCFs reported all deaths of residents in the previous 3 months, and structured questionnaires were sent to several proxies among which the treating physician. Method of statistical analysis: To control for clustering within LTCFs and countries, differences in involvement in care and recognition of the last phase of life were analyzed using multilevel analyses. Results and interpretation: Physician involvement varied widely between countries; in the last 3 months of life, residents from PL were visited most often (median: 15 times), compared to residents from FI (12), NL (10), BE (7), IT (6) and EN (5). In the last week of life, this ranged from 4 visits (NL) to 1 visit (EN). Among all countries, physicians from PL and IT least often recognized the resident's terminal phase in the last week of life (63.0% in PL up to 80.3% in NL), and least often initiated a palliative treatment (31.8% in IT up to 92.6% in NL). On overall level though, positive associations were found between the level of involvement and the recognition of the last phase of life and initiation of palliative care. LTCFs should therefore work together with and involve physicians as much as possible in caring for their residents.