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Open Access Highly Accessed Study protocol

Early identification of and proactive palliative care for patients in general practice, incentive and methods of a randomized controlled trial

Bregje Thoonsen1*, Marieke Groot1, Yvonne Engels1, Judith Prins2, Stans Verhagen1, Cilia Galesloot3, Chris van Weel4 and Kris Vissers1

Author Affiliations

1 Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands

2 Department of Medical Psychology, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands

3 Comprehensive cancer centre (IKNL), Postbus 1281, 6501 BG Nijmegen, The Netherlands

4 Department of Family Medicine, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands

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BMC Family Practice 2011, 12:123  doi:10.1186/1471-2296-12-123

Published: 3 November 2011

Abstract

Background

According to the Word Health Organization, patients who can benefit from palliative care should be identified earlier to enable proactive palliative care. Up to now, this is not common practice and has hardly been addressed in scientific literature. Still, palliative care is limited to the terminal phase and restricted to patients with cancer. Therefore, we trained general practitioners (GPs) in identifying palliative patients in an earlier phase of their disease trajectory and in delivering structured proactive palliative care. The aim of our study is to determine if this training, in combination with consulting an expert in palliative care regarding each palliative patient's tailored care plan, can improve different aspects of the quality of the remaining life of patients with severe chronic diseases such as chronic obstructive pulmonary disease, congestive heart failure and cancer.

Methods/Design

A two-armed randomized controlled trial was performed. As outcome variables we studied: place of death, number of hospital admissions and number of GP out of hours contacts.

Discussion

We expect that this study will increase the number of identified palliative care patients and improve different aspects of quality of palliative care. This is of importance to improve palliative care for patients with COPD, CHF and cancer and their informal caregivers, and to empower the GP. The study protocol is described and possible strengths and weaknesses and possible consequences have been outlined.

Trial Registration

The Netherlands National Trial Register: NTR2815