Study population
The GPs reported 495 deaths in a 1-year period in 2009. Sixty-one per cent (n = 279) of the deaths were non-sudden. Results are based on data of 279 patients with a non-sudden death (Table 1).
Table 1 Patient characteristics for non-sudden deaths (n = 279)
Eighty-two per cent of the patients were aged ≥65 years. More than half of the causes of death were malignancies; 63% of the patients died at home or in a care home, and 26% of the patients died in a hospital.
Important treatment aims
Important treatment aims in the three time periods studied are presented in Table 2.
Table 2 Importance of treatment aims in three time periods: months 2 and 3 before death, the 2–4 weeks before death, and the lastweek of life (n = 279).
Palliation was an important treatment aim in 73% of the patients in months 2 and 3 before death, increasing to 89% in the 2–4 weeks before death, and 95% in the last week of life.
Life prolongation became less important as death neared. Life prolongation was an important treatment aim in 25% of the patients in months 2 and 3 before death, in 18% in the 2–4 weeks, and in 9% of patients in the last week before death.
In addition, GPs reported that treatments aimed at cure were important in 22% of the patients in months 2 and 3 before death, in 11 % in the 2–4 weeks before death, and in 7% in the last week of life.
Figures 1 and 2 show important treatment aims for patients who died of cancer and for patients with another cause of death. These figures are based on the data of GPs who responded with a score of 4 or 5 for the question ‘How important were the following aspects of patient care?’.
Figure 1 Important treatment aims for patients with cancer.
Figure 2 Important treatment aims for non-cancer patients.
In the last week of life, there was a significant difference between patients with cancer and other patients concerning treatment aimed at cure (cancer: n = 4, 3% versus non-cancer: n = 13, 13%, P = 0.005). Hence in the very last days of life, cure was more frequently an important treatment aim for patients with a non-cancer cause of death than for patients with cancer. Also in the 2–4 weeks before death, cure was more frequently an important treatment aim in patients with a non-cancer cause of death than in patients with cancer (cancer: n = 8, 6% versus non-cancer: n = 16, 17%, P = 0.01). However, there were no significant differences regarding treatments aimed at cure in months 2 and 3 before death.
In addition, there were no significant differences between the percentages of patients with cancer and other patients, regarding treatments aimed at life prolongation in the three time periods.
In the 2–4 weeks before death, palliation was an important treatment aim in significantly more cancer patients compared with non-cancer patients (cancer: n = 128, 93% versus non-cancer: n = 77, 82%, P = 0.007). In the last week and in months 2 and 3 before death, there were no significant differences regarding treatments aimed at palliation.
