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.

  • Project description (ongoing research project)

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    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

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    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

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    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

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    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

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