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Increasing the number of patients receiving information about transition to end-of-life care: the effect of a half-day physician and nurse training
  1. L Martinsson1,
  2. P-A Heedman2,3,
  3. M Eriksson3,
  4. B Tavelin1,3 and
  5. B Axelsson3,4
  1. 1Department of Radiation Sciences, Umeå University, Umeå, Sweden
  2. 2Palliative Education and Research Centre in the County of Östergötland, Linköping, Sweden
  3. 3Swedish Register of Palliative Care, Kalmar, Sweden
  4. 4Department of Radiation Sciences, Unit of Clinical Research Centre—Östersund, Umeå University, Umeå, Sweden
  1. Correspondence to Dr L Martinsson, Department of Radiation Sciences, Umeå University, Umeå SE-901 87, Sweden; lisa.martinsson{at}


Introduction Honest prognostication and information for patients are important parts of end-of-life care. This study examined whether an educational intervention could increase the proportion of patients who received information about the transition to end-of-life (ITEOL care).

Method Two municipalities (in charge of nursing homes) and two hospitals were randomised to receive an interactive half-day course about ITEOL for physicians and nurses. The proportion of patients who received ITEOL was measured with data from the Swedish Register of Palliative Care (SRPC). Patients were only included if they died an expected death and maintained their ability to express their will until days or hours before their death. Four hospitals and four municipalities were assigned controls, matched by hospital size, population and proportion of patients receiving ITEOL at baseline.

Results The proportion of patients in the intervention group who received ITEOL increased from 35.1% (during a 6-month period before the intervention) to 42% (during a 6-month period after the intervention). The proportion in the control group increased from 30.4% to 33.7%. The effect of the intervention was significant (p=0.005) in a multivariable model adjusted for time, age, gender and cause of death.

Conclusion More patients at end-of-life received ITEOL after an educative half-day intervention directed to physicians and nurses.

  • Communication
  • Hospital care
  • Nursing Home care

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  • Contributors BA, LM and BT designed the study. P-AH, ME and BA conducted the intervention. BT and LM collected register data. LM, P-AH, ME, BT and BA carried out the data analysis and interpretation of the results. LM and BA drafted the manuscript, and P-AH, ME and BT revised it critically. LM submitted the manuscript. All authors gave approval of the submitted manuscript.

  • Funding This study was funded by the Swedish Register of Palliative Care, which receives financial support from the executive committee of the National Quality Registries in Sweden and from the Swedish government.

  • Competing interests None.

  • Ethics approval The local ethics committee in Umeå, Sweden.

  • Provenance and peer review Not commissioned; externally peer reviewed.