1. END-OF-LIFE CARE IN A PHYSICIAN’S WORK IN FINNISH HEALTH CENTRES Kosunen E, Hautala K, Fält A, Hinkka H, Lammi UK, Kellokumpu-Lehtinen P. Medical School University of Tampere Finland

2. Background Even if age-adjusted incidende of cancer diseases remained the same, the total number of cancer patients will increase in the future years in Finland large age cohorts get old, people live longer, high survival rates (among the best in Europe) a part of the growing work load will be transferred to primary health care, including end-of-life (EOL) care

3. Background… End-of-life (EOL) care in Finland: hospices: only in the biggest cities secondary care hospitals: regional hospitals central hospitals university hospitals primary care hospitals home care

4. Aims of the study To study general practitioners (GPs) involvement in cancer patients’ EOL care in Finnish health centres To study GPs’ experiences of EOL care To study GPs’ educational needs related to EOL care

5. Data collection A questionnaire was sent by mail in April 2003 The target group: all health centre physicians in Pirkanmaa Hospital District One reminded by post One reminder by e-mail to the chief physicians of the health centres

6. Material 319 questionnaires were sent 196 physicians responded 55 reported that they did not belong to the target group any more 141 had completed the questionnaire the response rate was 53 % (after excluding pollution)

7. Respondents’ background, % (n=141) GenderFemale66 Age (years)<4030 40-4941 50+29 Years since graduating<1021 10-1938 20 +39 Worked in this health center (years) <534 5+66 Specialist in GPno32 trainee22 yes46

8. Respondents’ involvement in cancer care (n=141) % Cancer patients in follow-up (n)None9 1-427 5-1035 10+28 Starting new follow-ups per yearNone6 1-461 5-1022 10+10

9. Involvement in end-of-life care 84 % (n=118) had ever treated EOL patients - mostly in primary care 17 % (n=24) had at least one EOL patient at the moment

10. Collaboration with hospitals (secondary care) in general, GPs were satisfied with the collaboration (consultations, help in acute problems) transfer of information was most often considered as bad or very bad (46%) Written information on finishing active treatments was often missing

11. Emotional stress (among GPs who had participated in EOL care, n=118) 72 % reported having experienced emotional stress when making ethical decisions in EOL care 12 % much or very much no significant differences by background factors men more than women ! (n.s.) 33 % reported that they had sometimes felt guilty because of EOL decisions Only 34 % had a possibility for supervision

12. Economic aspects in EOL care Influence of financial factors was asked related to treatment of pain (13%) antiemetic treatment (15%) specialist consultations (19%) Influence of financial factors was reported most often related to hospice care (40%)

13. Need of education and training: proportions of the responses quite/very much (n=118)

14. Discussion Response rate was quite low The respondents were experienced GPs, specialists more often than on average Probably this means that EOL treatment in PHC is mostly in experienced hands

15. Conclusions EOL care is not yet very usual in primary health care When trying to increase it, good collaboration with secondary care is crucial Supervision should be available

16. Thanks for your attention!

17. Statistics Newest survival rates Relative 1-year and 5-year survival rates for patients with malignant neoplasms followed up in 2003-2005. Only cancer sites with mean annual number of cases over 65 are included. In situ and borderline tumours are not included.