1 End-of-Life Care Research Group, Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.
2 Amsterdam Public Health Research Institute, Department of Public and Occupational Health, Expertise Center for Palliative Care, VU University Medical Center, Amsterdam, The Netherlands.
Palliat Med. 2018 Oct;32(9):1498-1508. doi: 10.1177/0269216318790386. Epub 2018 Jul 30.
Measuring the quality of palliative care in a systematic way using quality indicators can illuminate differences between patient groups.
To investigate differences in the quality of palliative care in primary care between people who died of cancer and people who died of organ failure.
Mortality follow-back survey among general practitioners in Belgium, the Netherlands, and Spain (2013-2014), and Italy (2013-2015). A standardized registration form was used to construct quality indicators regarding regular pain measurement, acceptance of the approaching end of life, communication about disease-related topics with patient and next-of-kin; repeated multidisciplinary consultations; involvement of specialized palliative care; place of death; and bereavement counseling.
SETTING/PARTICIPANTS: Patients (18+) who died non-suddenly of cancer, cardiovascular disease, or respiratory disease ( n = 2360).
In all countries, people who died of cancer scored higher on the quality indicators than people who died of organ failure, particularly with regard to pain measurement (between 17 and 35 percentage-point difference in the different countries), the involvement of specialized palliative care (between 20 and 54 percentage points), and regular multidisciplinary meetings (between 12 and 24 percentage points). The differences between the patient groups varied by country, with Belgium showing most group differences (eight out of nine indicators) and Spain the fewest (two out of nine indicators).
People who died of organ failure are at risk of receiving lower quality palliative care than people who died of cancer, but the differences vary per country. Initiatives to improve palliative care should have different priorities depending on the healthcare and cultural context.
使用质量指标系统地衡量姑息治疗的质量，可以揭示患者群体之间的差异。
调查比利时、荷兰和西班牙（2013-2014 年）以及意大利（2013-2015 年）初级保健中癌症死亡者和器官衰竭死亡者姑息治疗质量的差异。
对比利时、荷兰和西班牙以及意大利的全科医生进行死亡率随访调查（2013-2014 年）和意大利（2013-2015 年）。使用标准化登记表格构建质量指标，涉及定期疼痛测量、接受生命末期、与患者和家属讨论与疾病相关的主题；重复多学科咨询；涉及专门的姑息治疗；死亡地点；以及丧亲咨询。
设置/参与者：非突然死于癌症、心血管疾病或呼吸系统疾病的 18 岁及以上患者（n=2360）。
在所有国家，死于癌症的患者在质量指标上的得分均高于死于器官衰竭的患者，特别是在疼痛测量方面（在不同国家之间有 17-35 个百分点的差异）、专门姑息治疗的参与度（20-54 个百分点）和定期多学科会议（12-24 个百分点）。患者群体之间的差异因国家而异，比利时表现出的组间差异最大（9 项指标中的 8 项），西班牙表现出的组间差异最小（9 项指标中的 2 项）。
与死于癌症的患者相比，死于器官衰竭的患者接受姑息治疗的质量较低，但各国之间存在差异。改善姑息治疗的举措应根据医疗保健和文化背景制定不同的优先事项。
