How Often Do General Practitioners Communicate about End-of-Life Topics with Community-dwelling Older People and their Family in Three European Countries?

Background: The involvement of family in shared decision making and communication about medical issues at the end of life may be particularly relevant to older people, but it is unknown how often this happens in different countries.

Method: Nationwide representative mortality follow-back study among general practitioners (GPs), who filled in a weekly questionnaire regarding all their patients who died. The study included people who died non-suddenly over the age of 75 and whose longest place of residence in the last year of life was home (n=1556) in Belgium, the Netherlands and Italy in 2013, 2014 or 2015. GPs indicated if they had communicated with the patient and/or family about diagnosis, prognosis, approaching end of life, pros and cons of treatments, options for end-of-life care, spiritual issues and psychological or social issues.

Results: GPs communicated more often with older patients about all topics in Belgium (65%-81%) and the Netherlands (51%-87%) than in Italy (3-33%). On average, GPs in Belgium communicated with older patients about 3 out of 7 end-of-life topics, compared with 5 topics in the Netherlands and 1 topic in Italy. In all countries GPs communicated with family about an average of 4 topics, particularly diagnosis (75%-89%), prognosis (74%-90%) and the approaching end of life (71%-89%). In Belgium and Italy, all topics were more frequently discussed with family than with the patient; in the Netherlands, only options for end-of-life care were more frequently discussed with the family.

Conclusion: That communication between GP and family was similar in all countries suggest that family are seen as an appropriate avenue for communicating about end-of-life issues in different cultural settings, but whether this should be in conjunction with communication with the patient differs as shown by the substantial variance across countries in communication with older patients themselves.

Funding: None.