• Stéphanie Giezendanner, Klaus Bally, Dagmar M Haller, Corinna Jung, Ina C Otte, Hans-Ruedi Banderet, Bernice S Elger, Elisabeth Zemp, and Heike Gudat.
• 1 Department of Clinical Research, Faculty of Medicine, Center for Primary Health Care, University of Basel , Basel, Switzerland .
• J Palliat Med. 2018 Aug 1; 21 (8): 1122-1130.

BackgroundMany palliative care patients are admitted to hospital shortly before death even though the acute hospital setting is not considered ideal for end-of-life care (EOLC).ObjectivesThis study aimed to evaluate General Practitioners' (GPs') perspective on the frequency of and reasons for hospital referrals of these patients.MethodsCross-sectional survey involving a stratified random sample of 2000 GPs in Switzerland in 2014. GP characteristics, frequency and type of end-of-life transfers, reasons for referrals, confidence in EOLC, and regional palliative care provision were assessed. Multivariate regression analysis was performed to identify the variables associated with frequency of hospital referrals at the end of life.ResultsThe questionnaire was completed by 579 (31%) GPs. Frequent hospital referrals shortly before death were reported by 38%. GPs were less likely to report frequent hospitalizations when they felt confident in palliative care competencies, especially in anticipation of crisis. GPs were more likely to report frequent hospitalizations as being due to relatives' wishes, difficulties in symptom control, inadequate or absent care network, and the expense of palliative care at home.ConclusionsThe results suggest that adequate support of and a care network for palliative patients and their caregivers are crucial for continuous home-based EOLC. Timely recognition of the advanced palliative phase as well as the involvement of well-trained GPs who feel confident in palliative care, together with adequate financial support for outpatient palliative care, might diminish the frequency of transitions shortly before death.

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