Timing of GP end-of-life recognition in people aged ≥75 years: retrospective cohort study using data from primary healthcare records in England

Daniel Stow; Fiona E Matthews; Barbara Hanratty

doi:10.3399/bjgp20X713417

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Figure 1.
Percentage of clinical codes relating to end-of-life recognition and recording of preferences in 13 149 decedents in England.

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Identification of end of life can be challenging for clinicians, particularly in older people living with frailty. In this study, fewer than half of people aged ≥75 years who died had a code in their electronic health record (EHR) to suggest that their death was anticipated by their GP. End-of-life codes in EHRs were entered near to death (median 4 months prior). In the minority of older decedents (aged ≥75 years) for whom end of life was recognised, only a small proportion were on the palliative care register or had their preferences for place of care or death recorded.

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Table 1.
Demographic information from 13 149 people aged ≥75 years who died in England, between 1 January 2015 and 1 January 2016
Characteristic
Sex, n (%)
Female 7310 (55.6)
Male 5839 (44.4)

Mean age at month of death, years n, (SD)
All 86.6 (6.0)
Female 88.1 (6.1)
Male 85.7 (5.6)
SD = standard deviation.

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Table 2.

Twenty most common Read codes in first coded instance of end-of-life recognition in primary care, N = 13 149

Read Code description	n	%
Not for resuscitation	2232	17.0
Preferred place of care: home	1104	8.4
Preferred place of care: discussed with patient	671	5.1
Resuscitation: discussed with carer	657	5.0
Palliative care	579	4.4
On gold standards palliative care framework	523	4.0
Preferred place of care: care home	418	3.2
Preferred place of death: home	417	3.2
Preferred place of care: discussed with family	401	3.0
Preferred place of death: discussed with patient	361	2.7
Preferred place of care: nursing home	296	2.3
Preferred place of death: discussed with family	237	1.8
On end-of-life care register	231	1.8
Preferred place of death: care home	212	1.6
[V] Palliative care	198	1.5
Palliative care plan review	184	1.4
Has end-of-life advance care plan	180	1.4
Patient aware of diagnosis	159	1.2
Preferred place of death: nursing home	138	1.0
Referral to palliative care service	123	0.9

IQR = interquartile range.

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Table 3.

Preferred place of care in 2987 (22.7%) decedents for whom it was recorded

Preferred place of care	n^a	%
Home	1521	50.9
Care home	702	23.5
Nursing home	517	17.3
Hospital	134	4.5
Discussion not appropriate	40	1.3
Patient undecided	28	0.9
Hospice	22	0.7
Residential care	20	0.7
Community hospital	9	0.3
Relative’s home	4	0.1
Patient declined to participate	2	0.1

↵a Total = 2999 as some participants were asked more than once.

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Table 4.

Preferred place of death in 1713 (13.0%) decedents for whom it was recorded

Preferred place of death	n	%
Home	752	43.9
Care home	443	25.9
Nursing home	300	17.5
Residential home	70	4.1
Patient undecided	58	3.4
Hospice	47	2.7
Hospital	22	1.3
Usual place of residence	17	1.0
Community hospital	2	0.1
Patient declined discussion	2	0.1

Supplementary Data

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Supplementary material is not copyedited or typeset, and is published as supplied by the author(s). The author(s) retain(s) responsibility for its accuracy.