Palliative care service use in four European countries: a cross-national retrospective study via representative networks of general practitioners

PLoS One. 2013 Dec 30;8(12):e84440. doi: 10.1371/journal.pone.0084440. eCollection 2013.


Background: Due to a rising number of deaths from cancer and other chronic diseases a growing number of people experience complex symptoms and require palliative care towards the end of life. However, population-based data on the number of people receiving palliative care in Europe are scarce. The objective of this study is to examine, in four European countries, the number of people receiving palliative care in the last three months of life and the factors associated with receiving palliative care.

Methods: Cross-national retrospective study. Over two years (2009-2010), GPs belonging to representative epidemiological surveillance networks in Belgium, the Netherlands, Italy, and Spain registered weekly all deaths of patients (≥ 18 years) in their practices and the care they received in the last three months of life using a standardized form. Sudden deaths were excluded.

Results: We studied 4,466 deaths. GPs perceived to have delivered palliative care to 50% of patients in Belgium, 55% in Italy, 62% in the Netherlands, and 65% in Spain (p<.001). Palliative care specialists attended to 29% of patients in the Netherlands, 39% in Italy, 45% in Spain, and 47% in Belgium (p<.001). Specialist palliative care lasted a median (inter-quartile range) of 15 (23) days in Belgium to 30 (70) days in Italy (p<.001). Cancer patients were more likely than non-cancer patients to receive palliative care in all countries as were younger patients in Italy and Spain with regard to specialist palliative care.

Conclusions: Although palliative care is established in the countries studied, there are considerable differences in its provision. Two potentially underserved groups emerge non-cancer patients in all countries and older people in Italy and Spain. Future research should examine how differences in palliative care use relate to both patient characteristics and existing national health care policies.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Delivery of Health Care*
  • Europe
  • Female
  • General Practitioners*
  • Humans
  • Male
  • Neoplasms / mortality
  • Neoplasms / therapy*
  • Palliative Care*
  • Retrospective Studies

Grant support

Funding for the study came from the Institute for the Promotion of Innovation by Science and Technology in Flanders ( as a Strategic Basic Research project (SBO) (contract SBO IWT 050158) (2006–2010), as part of the ‘Monitoring Quality of End-of-Life Care (MELC) Study’, a collaboration between the Vrije Universiteit Brussel, Ghent University, Antwerp University, the Scientific Institute for Public Health, Belgium, and VU University Medical Center Amsterdam, the Netherlands. Funding also came from the Italian Ministry of Health ( through the ‘Evaluation, testing and implementation of supportive care, care interventions, integrated programs and improving the quality of care for cancer patients’ program (‘Integrated Oncology Project n°6, years 2008–2011’) led by Massimo Costantini (IRCCS AOU San Martino-IST, Genoa), from the annual budgets of the Autonomous Community of Castilla y León ( and Comunitat Valenciana ( and from EURO IMPACT: European Intersectorial and Multidisciplinary Palliative Care Research Training, funded by the European Union Seventh Framework Programme (FP7/2007–2013, under grant agreement n° [264697], The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.