Helping lay carers of people with advanced cancer and their GPs to talk: an exploration of Australian users' views of a simple carer health checklist

[What prevention potential does the general practitioner setting offer for family caregivers?-findings from a qualitative interview study]

The support of people in need of care and assistance is often provided by caring relatives. General practitioners can play an important role in supporting this group, if they adapt to the problems and wishes of family caregivers.The aim of the exploratory study is to contrast care needs of family caregivers regarding the GP support with actually experienced care and, thereby, work out approaches for strengthening the GP's role.A total of 37 family caregivers were recruited via 13 internet forums focused on caregiving. Telephone interviews were conducted between September 2020 and March 2021.The majority of those interviewed consider the GP to be an important support body with a high level of competence and trust. The interviewees praise the GP's knowledge of the personal care situation, the responsiveness to a wide variety of problems and the focus on those in need of care. However, communication about the caring activity is often delayed significantly (late identification and addressing of family caregivers). GPs do not always address the needs of relatives to the same extent as they do to those in need of care. Only some of the doctors refer caregivers to offers of help and support.GPs can play a central role in supporting family caregivers. An crucial prerequisite for this is that family caregivers are recognized and involved at an early stage. In addition, it is important that GPs take into account the needs, desires and stresses of both caregivers and those being cared for. Consistent references to offers of help make it easier for family caregivers to organize care and to receive (psychosocial) support.

Supporting family carers in general practice: a scoping review of clinical guidelines and recommendations

BACKGROUND

Increasing numbers of family carers are providing informal care in community settings. This creates a number of challenges because family carers are at risk of poor physical and psychological health outcomes, with consequences both for themselves and those for whom they provide care. General Practitioners (GPs), who play a central role in community-based care, are ideally positioned to identify, assess, and signpost carers to supports. However, there is a significant gap in the literature in respect of appropriate guidance and resources to support them in this role.

METHODS

A scoping review was undertaken to examine clinical guidelines and recommendations for GPs to support them in their role with family carers. This involved a multidisciplinary team, in line with Arksey & O'Malley's framework, and entailed searches of ten peer-reviewed databases and grey literature between September-November 2020.

RESULTS

The searches yielded a total of 4,651 English language papers, 35 of which met the criteria for inclusion after removing duplicates, screening titles and abstracts, and performing full-text readings. Ten papers focused on resources/guidelines for GPs, twenty were research papers, three were review papers, one was a framework of quality markers for carer support, and one was an editorial. Data synthesis indicated that nine (90%) of the guidelines included some elements relating to the identification, assessment, and/or signposting of carers. Key strategies for identifying carers suggest that a whole practice approach is optimal, incorporating a role for the GP, practice staff, and for the use of appropriate supporting documentation. Important knowledge gaps were highlighted in respect of appropriate clinical assessment and evidence-based signposting pathways.

CONCLUSION

Our review addresses a significant gap in the literature by providing an important synthesis of current available evidence on clinical guidelines for GPs in supporting family carers, including strategies for identification, options for assessment and potential referral/signposting routes. However, there is a need for greater transparency of the existing evidence base as well as much more research to evaluate the effectiveness and increase the routine utilisation, of clinical guidelines in primary care.

Supporting family carers in Ireland: the role of the general practitioner

BACKGROUND

Ireland has over half a million family carers who provide care to a family member or loved one. Internationally, it is recognised that general practitioners (GPs) have a critical role to play in the identification and support of family carers, but, to date, no guidelines exist in Ireland to support GPs in this role.

AIMS

The aim of this study was to examine how carers are currently supported (or not) by healthcare professionals in Ireland, with a particular focus on the role of the GP.

METHODS

A mixed method design was used, involving a national online survey (N = 132) of family carers in Ireland and one-to-one interviews with 10 stakeholders (4 GPs; 6 carers). The quantitative data were analysed using a series of descriptive and inferential statistics; the interview data were analysed using framework analysis.

RESULTS

Sixty-one per cent of the carer sample reported experiencing psychological distress, more than two-thirds of whom (69%) reported 'rarely' or 'never' being asked about their own health and wellbeing. Sixty-one per cent also felt misunderstood in terms of the challenges they face in their caring role. Three key themes were identified from the interview data including (1) GP role ambiguity; (2) navigating informal processes and (3) changing needs along the care trajectory.

CONCLUSIONS

The findings suggest important gaps in terms of the role of GPs vis-à-vis their support of family carers. GPs themselves indicated that they need both greater clarity regarding their role with family carers and more training and resources in this regard. A requirement for more streamlined communication and information provision was also highlighted by both GPs and carers. Carers reported a need for more information on the role of GPs in supporting carers as well as more support in addressing, in particular, the psychological complexities of carer identity and help seeking.

Prerequisites for providing effective support to family caregivers within the primary care setting - results of a study series in Germany

Background

General Practitioners are considered to be well placed to monitor home-care settings and to respond specifically to family caregivers. To do this, they must be sensitive to the needs and expectations of caregivers. In order to determine the current status of GP care in terms of the support given to family caregivers, a series of studies were conducted to gather the perspectives of both caregivers and GPs. The results are used to derive starting points as to which measures would be sensible and useful to strengthen support offered to family caregivers in the primary care setting.

Methods

Between 2020 and 2021, three sub-studies were conducted: a) an online survey of 612 family caregivers; b) qualitative interviews with 37 family caregivers; c) an online survey of 3556 GPs.

Results

Family caregivers see GPs as a highly skilled and trustworthy central point of contact; there are many different reasons for consulting them on the subject of care. In the perception of caregivers, particular weaknesses in GP support are the absence of signposting to advisory and assistance services and, in many cases, the failure to involve family caregivers in good time. At the same time, GPs do not always have sufficient attention to the physical and psychological needs of family caregivers. The doctors interviewed consider the GP practice to be well suited to being a primary point of contact for caregivers, but recognise that various challenges exist. These relate, among other things, to the timely organisation of appropriate respite services, targeted referral to support services or the early identification of informal caregivers.

Conclusions

GP practices can play a central role in supporting family caregivers. Caregivers should be approached by the practice team at an early stage and consistently signposted to help and support services. In order to support care settings successfully, it is important to consider the triadic constellation of needs, wishes and stresses of both the caregiver and the care recipient. More training and greater involvement of practice staff in the support and identification of caregivers seems advisable.

[General practitioners, attitudes, procedures and challenges towards supporting family caregivers - results of a survey of primary care physicians]

BACKGROUND

 General practitioners are considered to be well suited when it comes to addressing the information and care needs of family caregivers. The aim of the present study is to examine how general practitioners assess their possibilities to support caregivers, what priorities they set and to what extent they experience challenges.

METHODS AND PARTICIPANTS

 In the course of an online survey with a postal cover letter, a total of 3,556 GPs in in Baden-Württemberg, Hesse and Rhineland-Palatinate were interviewed between February and June 2021. Due to the exploratory approach of the study, only a descriptive data analysis was carried out.

RESULTS

 68 % of the GPs surveyed often deal with family caregivers in everyday practice; 77 % consider the GP's office to be well suited as the primary point of contact for family caregivers and care coordination. Often it is caregiving relatives who ask the GP about the issue of care (89 %). Frequent contents concern a deterioration in the care situation (75 %) and a change in the need for care (84 %); consultations in the initial phase of care are less common (40 %). There are differences between urban and rural doctors in the perception of the needs of caregivers and the setting of priorities. Rural doctors give more weight to proactive and psychosocial care, whereas doctors in urban regions rely on the specialist and support network. GPs experience various challenges while supporting caregivers, including the timely organization of suitable relief offers (87 %), the referral to suitable offers of help (79 %) or the early identification of informal caregivers (59 %).

DISCUSSION

 GPs can play a central role in supporting family caregivers. A crucial prerequisite for this is that family caregivers are recognized and involved at an early stage. Consistent references to offers of help make it easier for family caregivers to organize care and to receive (psychosocial) support. In addition, it is important that GPs take into account the needs, desires and stresses of both caregivers and those being cared for.

Engaging Carers in Co-Design: Development of the Carer Readiness Tool

Introduction

The Carer Support Unit (CSU) of the Central Coast Local Health District (CCLHD), NSW, Australia, developed, trialled and implemented a Carer Readiness Tool (CRT) to help carers gauge their readiness to care at home, highlight to hospital staff areas for additional support for carers, and provide evidence of carer engagement in discharge planning.

Description

A rigorous co-design process was followed with carer consultation at key milestones in development of the CRT. The tool was piloted in two cancer/chronic renal disease inpatient units commencing November 2019.

Discussion

The CRT was well-received by carers who appreciated the opportunity to complete the tool in their own time, not in front of the patient. Positive feedback was received from clinicians, including the breadth of the CRT's content which contributed to better discharge planning. The need to manually incorporate a hard copy form into the electronic medical record is a limitation of the CRT.

Conclusion

The CRT is context-specific and fit for purpose. During the development of the CRT, the project team focused on the face validity and usefulness of the tool. The next stage of the project will be formal evaluation of the tool to measure its impact.

Support for Australian carers from community pharmacy: Insight into carer perspectives of a novel service

The feasibility of an individualised carer support service delivered in community pharmacies was assessed from the perspective of carer participants using a pre-post questionnaire and semistructured interviews. Eligible pharmacies were required to offer a medication management service relevant to carers and have a semiprivate space for conversations. Carers were required to self-identify as an unpaid support person for someone with a chronic condition or disability. Between September 2016 and March 2017, staff from 11 community pharmacies in South-East Queensland, Australia were trained, and provided with ongoing mentoring from a pharmacist and carer to support service implementation. Identification of carers and support to achieve a personal and care-giving goal were key features of the service. Questionnaires included the EQ-5D-3L, the Bakas Caregiving Outcomes Scale, and questions relating to goal achievement, carer roles, and responsibilities. Seven follow-up carer interviews were undertaken between March and May 2017 and analysed thematically. Pre-post questionnaires were available for 17 carers (one withdrew, two incomplete). Of the 29 goals set, 10 were achieved and 14 partially achieved. EQ-5D-3L scores were unchanged, while 7 of the 15 items comprising the Bakas score improved (p < 0.05). Carer service evaluation was generally favourable, and these two main interview themes were the impact of caring and pharmacy experience. The impact of caring, while variable, was significant. Pharmacy experiences were mostly positive and the opportunity for carers to further engage with pharmacy staff was appreciated. The service was feasible and initial reported benefits to carers may support further research potentially in terms of a larger controlled trial.

General practice palliative care: patient and carer expectations, advance care plans and place of death-a systematic review

BACKGROUND

With an increasing ageing population in most countries, the role of general practitioners (GPs) and general practice nurses (GPNs) in providing optimal end of life (EoL) care is increasingly important.

OBJECTIVE

To explore: (1) patient and carer expectations of the role of GPs and GPNs at EoL; (2) GPs' and GPNs' contribution to advance care planning (ACP) and (3) if primary care involvement allows people to die in the place of preference.

METHOD

Systematic literature review.

DATA SOURCES

Papers from 2000 to 2017 were sought from Medline, Psychinfo, Embase, Joanna Briggs Institute and Cochrane databases.

RESULTS

From 6209 journal articles, 51 papers were relevant. Patients and carers expect their GPs to be competent in all aspects of palliative care. They valued easy access to their GP, a multidisciplinary approach to care and well-coordinated and informed care. They also wanted their care team to communicate openly, honestly and empathically, particularly as the patient deteriorated. ACP and the involvement of GPs were important factors which contributed to patients being cared for and dying in their preferred place. There was no reference to GPNs in any paper identified.

CONCLUSIONS

Patients and carers prefer a holistic approach to care. This review shows that GPs have an important role in ACP and that their involvement facilitates dying in the place of preference. Proactive identification of people approaching EoL is likely to improve all aspects of care, including planning and communicating about EoL. More work outlining the role of GPNs in end of life care is required.