Specialist multidisciplinary palliative care provision and palliative care by general practitioners: a comparative study via GP networks in Belgium, Italy, the Netherlands and Spain

Background. Population-based studies comparing palliative care service use across countries, diseases and care settings are scarce.
Research question. This study compared use and time of onset of specialist multidisciplinary palliative care initiatives (SMPC) and use of palliative care provided by general practitioners (GPs) in Belgium (BE), the Netherlands (NL), Italy (IT) and Spain (ES) and analysed determinants of receiving these types of care across countries.
Methods. As part of the Euro SENTI-MELC study, in all four countries representative networks of GPs retrospectively registered deaths of their patients who had died in 2009-2010 (BE, NL and IT) and in 2010 (ES) using standardized registration forms assessing care in the last three months of life, pathology and patient characteristics. Sudden deaths were excluded.
Results. We studied N=4466 patients (aged under 18y) dying non-suddenly. GPs provided palliative care most often in ES (65%) and NL (62%) and less often in IT (55%) and BE (50%). MPCI were delivered most often in BE (46%) and ES (44%), less often in IT (39%) and least often in the NL (29%). Country-differences remained significant after adjustment for age, sex,and cause and place of death. The median time of onset of MPCI before death was shortest in BE (15 days) and longest in IT (30 days) and differed significantly between countries (pConclusion. A possible explanation of the observed differences could lie in country-specific organization of palliative care and health care policies.