Stockholm Östergötland Halland Skåne Gotland Västerbotten Jönköping Kalmar SWEDEN Uppsala Västra Götaland Kronoberg Örebro Västernorrland Blekinge Norrbotten Värmland Gävleborg Jämtland Sörmland Dalarna Västmanland
Coverage of Palliative Care Register, % 41 69 49 43 67 63 73 72 59 59 55 72 67 71 75 59 76 78 76 65 74 69
51.0 44.9 44.7 44.4 43.1 40.3 39.0 38.8 38.3 37.4 37.3 36.1 36.1 35.7 35.1 32.9 29.9 29.8 28.8 28.7 27.5 27.0 20
0
40
60
Figure 166
80
100 Percent
2011
Percentage of patients for whom end-of-life conversations were held, January-June 2012. Source: Swedish National Registry of Palliative Care
that care is entering a new phase that does not seek to extend life. Not every patient wants to hear the entire truth – at least not during the initial conversation. Some terminal patients are no longer able to actively participate in discussions about their care and the direction it is heading. In such cases, talking to family members or other people close to the patient is vital. The doctor must be fully involved. The Swedish National Registry of Palliative Care reflects these needs. Caregivers previously responded to the question as to whether an end-of-life conversation had been held. The question was reworded in 2011 to better capture active participation by the doctor, as well as documentation of such conversation in the medical records. The presentation includes only patients for whom caregivers responded in the affirmative when asked whether death had been expected. Whether the patient was able to take part in treatment decisions and whether family members were present are also taken into consideration. As a result of these changes, the register now targets end-of-life conversations for 100 per cent of patients. Figure 166 shows the percentage of patients for whom documented end-of-life conversations were held during the first half of 2012. The comparison included almost 18 000 patients.
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QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2012