LTCF-Physician Collaboration Helps Ensure Timely Palliative Care at End of Life

June 12, 2019

Joint collaboration between long-term care facilities (LTCFs) and physicians can facilitate the recognition of a resident’s terminal phase and help ensure timely provision of palliative care, according to a new study in the June issue of JAMDA.

In Physician Visits and Recognition of Residents’ Terminal Phase in Long-Term Care Facilities: Findings from the PACE Cross-Sectional Study in 6 EU Countries, the authors looked at LTCFs in Belgium, England, Finland, Italy, the Netherlands, and Poland. They examined elements including the number of physician visits, the residents’ main treatment goal, and whether physicians recognized residents’ terminal phase and expected each person’s death. They found that the number of physician visits to residents varied significantly between countries (ranging from 15 visits in the last week of life to one) and that physicians from Poland and Italy were least inclined to recognize when a resident was in the terminal phase. Overall, however, the authors found a positive association between the number of physician visits and the recognition of a resident’s terminal phase; as well as a correlation between number of physician visits and residents having palliation as a main treatment goal in the last week of life.

“As more physician visits allow for more opportunity to interact with the resident, staff, and family, it is likely that a higher amount of physician visits results in a more complete picture of the resident’s condition,” the authors noted. “Although caution should be applied in interpreting the direction of causality, it seems that physician visits over a longer period of time contribute to a better and earlier recognition of imminent death.”

This study was conducted by researchers in the Department of Public and Occupational Health and the Department of General Practice & Elderly Care Medicine at the Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research, Amsterdam, The Netherlands; Leiden University Medical Center, Department of Public Health and Primary Care, Leiden, The Netherlands; Radboud University Medical Center, Department of Primary and Community Care, Nijmegen, The Netherlands; International Observatory on End-of-Life Care, Lancaster University, United Kingdom; End-of-Life Care Research Group, Vrije Universiteit Brussels (VUB) and Ghent University, Brussels, Belgium; Department of Internal Medicine & Geriatrics, Universita Cattolica del Sacro Cuore, Rome, Italy; the National Institute for Health and Welfare, Helsinki, Finland; and the Unit for Research on Ageing Society, Epidemiology and Preventive Medicine Chair, Medical Faculty, Jagiellonian University Medical College, Krakow, Poland.

Click here for more information on the findings above and more details about the study. To contact the researchers or JAMDA editor for an interview, please email



JAMDA is the official journal of AMDA – The Society for Post-Acute and Long-Term Care Medicine. JAMDA publishes peer-reviewed articles including original studies, reviews, clinical experience articles, case reports, and more, on all topics more important to post-acute and long-term care medicine. Visit for more information.

About the Society for Post-Acute and Long-Term Care Medicine
AMDA – The Society for Post-Acute and Long-Term Care Medicine is the only medical specialty society representing the community of over 50,000 medical directors, physicians, nurse practitioners, physician assistants, and other practitioners working in the various post-acute and long-term care (PALTC) settings. Dedicated to defining and improving quality, we advance our mission through timely professional development, evidence-based clinical guidance, and tireless advocacy on behalf of members, patients, families, and staff. Visit for more information.