• Natalie Evans, Massimo Costantini, H R Pasman, Lieve Van den Block, Gé A Donker, Guido Miccinesi, Stefano Bertolissi, Milagros Gil, Nicole Boffin, Oscar Zurriaga, Luc Deliens, Bregje Onwuteaka-Philipsen, and EURO IMPACT.
• Department of Public and Occupational Health, EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: n.evans@vumc.nl.
• J Pain Symptom Manage. 2014 Mar 1;47(3):604-619.e3.

ContextEffective communication is central to high-quality end-of-life care.ObjectivesThis study examined the prevalence of general practitioner (GP)-patient discussion of end-of-life topics (according to the GP) in Italy, Spain, Belgium, and The Netherlands and associated patient and care characteristics.MethodsThis cross-sectional, retrospective survey was conducted with representative GP networks. Using a standardized form, GPs recorded the health and care characteristics in the last three months of life, and the discussion of 10 end-of-life topics, of all patients who died under their care. The mean number of topics discussed, the prevalence of discussion of each topic, and patient and care characteristics associated with discussions were estimated per country.ResultsIn total, 4396 nonsudden deaths were included. On average, more topics were discussed in The Netherlands (mean=6.37), followed by Belgium (4.45), Spain (3.32), and Italy (3.19). The topics most frequently discussed in all countries were "physical complaints" and the "primary diagnosis," whereas "spiritual and existential issues" were the least frequently discussed. Discussions were most prevalent in The Netherlands, followed by Belgium. The GPs from all countries tended to discuss fewer topics with older patients, noncancer patients, patients with dementia, patients for whom palliative care was not an important treatment aim, and patients for whom their GP had not provided palliative care.ConclusionThe prevalence of end-of-life discussions varied across the four countries. In all countries, training priorities should include the identification and discussion of spiritual and social problems and early end-of-life discussions with older patients, those with cognitive decline if possible, and those with non-malignant diseases.Copyright © 2014 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

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