Terminale zorg aan oncologische patiënten in de huisartsenpraktijk; frequentie, inhoud en ervaren belasting

In a retrospective study we analysed the frequency and background of terminal care for cancer patients as provided by general practitioners. In the period 1994-1999, 94 patients died of cancer in five central Netherlands general practices covering 13,000 patients, an average of 4 patients per practice per year. Data on morbidity and GP management were derived from the electronic medical records in the practices and data on the qualitative aspects of care were collected via structured interviews with the GP involved. The mean time period from diagnosis till death was 10 months. Morbidity dealt with by the GPs in the final phase of life consisted mainly of pain (78% of patients) gastro-intestinal symptoms (64%) fatigue (66%) dyspnoea (56%) and psychiatric problems (43%). Management by GPs mainly focused on pharmacotherapy, with only a limited number of technical interventions being required. In almost half the patients a specialist was consulted. The number of patient-doctor contacts rose in the terminal phase of life by a factor of six. GPs were satisfied with management in 73% of the patients, though the emotional burden was often considered severe and the medical problems difficult. Satisfaction on the part of the GP showed a positive association with the number of patient-doctor contacts. We concluded that terminal care of oncology patients in general practice is relatively rare, intensive and complex. GPs do, however, regard it as rewarding. Specialist consultation offers an important form of support in the primary care management of terminal cases.