Primary care professionals should play a proactive role in caring for patients at the end of life, according to family medicine specialists at the National Congress of the Spanish Society of Family and Community Medicine (semFYC) held in Madrid, Spain.

The session focused on the role of primary care in anticipating needs, coordinating care, and supporting patients to remain in their preferred care settings whenever possible.

The session was moderated by Marta Merlo Loranca, MD, a physician at the Hospital Universitario de Getafe, Madrid, Spain, and the coordinator of the Palliative Care Working Group of the Madrid Society of Family and Community Medicine.

End-of-Life Care

According to Merlo Loranc, “talking about the place of death is not only important from a statistical or logistical perspective, it is also an ethical, social, and organizational expression of how our society, and specifically the healthcare system, supports a person through the end of life.”

“It also addresses issues such as accompaniment, suffering, and whether we truly respect patients’ preferences or ignore them,” she stated. “Without doubt, the place of death is an indicator of quality and equity.”

María Varela Cerdeira, MD, also participated in this session. She is a specialist in family and community medicine at the Palliative Care Department, La Paz Hospital, Madrid, Spain, and coordinates with the Palliative Care Working Group, a professional section within the semFYC.

“Patients prefer to die at home, yet most deaths occur in hospital, which should prompt reflection,” said Varela Cerdeira.

She noted that the factors associated with death at home included older age, nononcologic disease, severe dependency, and lower clinical complexity. “The primary care team is the one that best knows the patient’s home environment,” she added.

In contrast, death in hospital reflects what she described as “a clear institutionalization of the final phase of life in developed countries.” “The hospital setting does not provide a good quality of death. With comparable symptom control, the patient was followed up at home and underwent fewer invasive interventions and reported greater satisfaction,” she said.

According to the SUPPORT study, dying in a hospital is often associated with avoidable suffering, excessive use of technology, limited communication, and insufficient care planning. “Isolated interventions, such as providing information and support only in hospitals, are insufficient. What is needed is systemic change and a proactive approach from primary and palliative care,” Varela Cerdeira said.

Patricia Estevan Burdeus, a specialist in family and community medicine at the Centro de Salud Arroyo Media Legua in Madrid, Spain, addressed population mortality patterns. She began by asking, “What do we die from?” and referred to the epidemiologic transition model described by Abdel Omran in 1971.

In Spain, cancer has been the leading cause of death in recent years, followed by circulatory and respiratory diseases.

A 2019 study found that 60% of patients living in Spain preferred to die at home. In medium-sized and large cities, 25% of cancer deaths occur at home, 66% in hospitals, and 8% in residential care facilities.

In towns with fewer than 10,000 inhabitants, 32% of deaths occurred at home, 58.6% in hospitals, and 8% in residential care facilities.

Death at home was more frequently associated with women, married individuals, individuals with higher educational attainment, older age, and residence in small- or medium-sized communities. Death in hospital was more often associated with men who were single, divorced, or widowed; younger age; lower educational level; and residence in large cities.

In the final days of life, Estevan Burdeus called for “greater measures to support patients and caregivers,” including improved work-life balance and social support. She also stressed the need to “improve access to healthcare services.”

“We must support patients and respect their preferences regarding the place of care and death. Accompanying them through illness and dying undoubtedly alleviates suffering,” she said.

Speakers have noted that evidence and clinical experience suggest that how patients die is more important than where or with whom they will die. Although many individuals with advanced chronic disease prefer to die at home, representatives from semFYC cautioned that “dying at home, in itself, may not be a reliable indicator of the quality of end-of-life care.”

“The family doctor plays a fundamental role within a team-based approach influenced by many factors,” they said.

For this reason, family physicians at the Madrid congress examined barriers to dying at home and discussed “successful strategies to accompany and care for patients at home for as long as possible, including providing support at the end of life.”

Estevan Burdeus and Varela Cerdeira disclosed having no relevant financial relationships.

This story was translated from El Medico Interactivo, part of the Medscape Professional Network.