End‐of‐life care of nursing home residents: A survey among general practitioners in northwestern Germany.

Aim: To describe general practitioners' (GPs) perspectives on end‐of‐life care of nursing home residents. Methods: We carried out a cross‐sectional study. A questionnaire was sent to a random sample of 1121 GPs in the German federal states of Bremen and Lower Saxony in 2018. Data were compared between GPs with a qualification in palliative medicine and those without such qualifications, and multivariable logistic regression was performed. Results: Overall, 375 questionnaires were returned (response rate 34%). The majority of GPs (71%) agreed that nursing home residents are treated too often in hospitals at the end of life, and more than half rated end‐of‐life care in nursing homes as "rather poor" (54%). For both questions, GPs with a qualification in palliative medicine showed higher agreements. In the multivariable analysis, a prior qualification in palliative medicine was also strongly associated with rating end‐of‐life care as "rather poor" (OR 1.89, 95% CI 1.10–3.23). Respondents cited higher staffing ratios and better trained nursing staff as the most important measures to improve end‐of‐life care. Furthermore, it was estimated that just 37% of residents have an advance directive, with only one‐third including valid information on end‐of‐life hospitalizations. Conclusions: This study showed that GPs tend to be critical regarding end‐of‐life care in nursing homes. To improve end‐of‐life care, better training in palliative care for nursing staff and GPs might be warranted. In addition, advance care planning can help to ensure that residents' wishes are respected. Geriatr Gerontol Int 2020; 20: 25–30. [ABSTRACT FROM AUTHOR]