Improving End-of-life Care by Continuing Medical Education and Electronic Decision Making Support for General Practitioners

Study Overview
=================
Brief Summary
-----------------
Background: Optimizing the basic palliative care has been shown beneficial to patients in end-of-life care, the general practitioner (GP) having a pivotal role in the health care system, providing comprehensive and continued medical care. The aim of the study is to investigate the effect of a complex intervention in general practice on GPs' awareness of and confidence in providing end-of-life care. Method: A follow-up study among 404 general practices in Central Denmark Region. The participating general practices will get the opportunity to receive education in palliative care and access to an electronic support, which provides advice on palliative care and an overview of the palliative population in each medical practice. The education and the support will focus on patients suffering from either metastatic cancer or chronic obstructive pulmonary disease (GOLD stage 4). The end-of-life care delivered by the GPs to their deceased patients will be analysed, based on questionnaires to GPs and register data related to the deceased patients before and after the intervention, . Primary outcomes: Place of death of deceased patients, time spent at home, and number of hospital admissions in the last three months of the patients' lives. Secondary outcomes: Number and kinds of contacts between GPs and patients, use of relevant medicine and of the 'Safety Box'. Finally GPs' confidence concerning palliative care will be assessed in questionnaires.

Official Title
-----------------
Improving End-of-life Care by Continuing Medical Education and Electronic Decision Making Support for General Practitioners in Denmark - an Intervention Study

Conditions
-----------------
Chronic Obstructive Pulmonary Disease, Metastatic Cancer

Intervention / Treatment
-----------------
* Other: continuing medical education and electronic decision support
* Other: education and electronic support


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Working as General Practitioner in the Central Region of Denmark in 2013 and onwards - Exclusion Criteria: -
Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Supportive Care
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: general practioner<br> | Other: continuing medical education and electronic decision support<br> <br> Other: education and electronic support<br>* Continuing medical education and electronic decision support to General Practitioners.<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Place of death of deceased patients | Looking at the proportion of General practitioners patients dying at home in the year following the continuing medical education meeting | 1 year | 
| time spent at home the last three months of the deceased patients lives | Looking at all the deceased patients in one year following the continuing medical education meeting | 3 months | 
| Numbers of hospital admission the last three months of the deceased patients lives | Looking at all the deceased patients in one year following the continuing medical education meeting | 3 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| and kinds of contacts between GPs and patients in the last three months of the deceased patients lives |  | three months | 
| use of relevant medicine and of the 'Safety Box' in the last three months of the deceased patients lives |  | three months | 
| GPs' confidence concerning palliative care | assessed using questionnaire before and after the intervention | 14 months | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Palliative care, Continuing medical education, General practitioner, Electronic decision support