• Birgit Aabom, Jakob Kragstrup, Hindrik Vondeling, Leiv S Bakketeig, and Henrik Stovring.
• Research Unit for General Practice, University of Southern Denmark, J.B. Winsloøws Vej 9A, 5000 Odense C, Denmark. baabom@health.sdu.dk
• Palliat Med. 2006 Jul 1;20(5):507-12.

ObjectiveTo analyse the effect of GP home visits on the granting of a terminal declaration (TD) and on place of death.Participants And DesignA total of 2025 patients with cancer as the primary cause of death in the period 1997-1998, were investigated in a mortality follow-back design using the Danish Cancer Register and four administrative registers. The Danish TD can be issued by a physician for patients with an estimated prognosis of six months or less. The TD gives the right to economic benefits and increased care for the dying patient.SettingThe island of Funen/Denmark.Main Outcome MeasuresMain outcome--hospital death. Intermediate outcome--TD.ResultsA total of 38% of patients received a TD and 56% died in hospital. GP home visits in the week before TD (odds ratio (OR): 16.8; 95% CI: 8.2-34.4), as well as four weeks before TD (OR: 6.4; 95% CI: 4.5-9.2) were associated with an increased likelihood of receiving a TD. GP home visits in the group with TD (OR: 0.18; 95% CI: 0.11-0.29) and the group without TD (OR: 0.08; 95% CI: 0.05-0.13) was inversely associated with hospital death. A dose-response relationship was found in both groups.ConclusionPersistent involvement by the GP is associated with improved end-of-life care for cancer patients. Provided that temporal relations are taken into account, the mortality follow-back design can be a suitable and ethical research method to highlight and monitor end-of-life cancer care.

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