[General practice management and therapy of terminally ill patients--a longitudinal study]

Since most persons in Germany die outside a hospital, the aim of the study was to quantify GP and nursing services for persons in the ten weeks prior to death. GPs were asked to document patients they considered to be terminal, using a set of different documentation sheets: 1. age, sex, living situation, and diagnoses, 2. time, place, duration, services, and nursing intensity for every contact and 3. circumstances of death. GPs were told to expect three-month periods to be documented. Twenty-six practices participated, documenting 47 patients and 582 contacts. Mean age of the deceased was 76 years (31 to 98); 21 were male and 26 female. Patients were classified as "terminal" on average 70 days prior to death (median 50 days). Average number of doctor-patient contacts increased from 0.7/week to 1.6 in the third and second last week and 2.4 in the final week. Average number of hospital days were around 1.1/week for the whole period. Nursing hours by relatives increased to over 13 h/day in the final week. Professional home nursing services were available for 80% in the final week, but only for 3 h/day. Thirty-two patients (68%) died at home, 7 (15%) in a nursing home and 8 (17%) in hospital (after a mean of 6 days as in-patients). The results document the large amount of time needed by physicians, relatives and nurses in the last weeks of life for persons who die at home.