Does persistent involvement by the GP improve palliative care at home for end-stage cancer patients?
OBJECTIVE: To analyse the effect of GP home visits on the granting of a terminal declaration (TD) and on place of death. PARTICIPANTS AND DESIGN: A total of 2025 patients with cancer as the primary cause of death in the period 1997-1998, were investigated in a mortality follow-back design using the Danish Cancer Register and four administrative registers. The Danish TD can be issued by a physician for patients with an estimated prognosis of six months or less. The TD gives the right to economic benefits and increased care for the dying patient. SETTING: The island of Funen/Denmark. MAIN OUTCOME MEASURES: Main outcome–hospital death. Intermediate outcome–TD. RESULTS: A total of 38% of patients received a TD and 56% died in hospital. GP home visits in the week before TD (odds ratio (OR): 16.8; 95% CI: 8.2-34.4), as well as four weeks before TD (OR: 6.4; 95% CI: 4.5-9.2) were associated with an increased likelihood of receiving a TD. GP home visits in the group with TD (OR: 0.18; 95% CI
