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Pereira J, Herx L, Simoni J, Klinger CA. Mapping primary and generalist palliative care: Taking a closer look at the base of the pyramid. Palliat Med 2024:2692163241265255. [PMID: 39069668 DOI: 10.1177/02692163241265255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Affiliation(s)
- Jose Pereira
- University of Navarra, Institute for Culture and Society and Faculty of Medicine, Pamplona, Spain
- McMaster University, Department of Family Medicine and Division of Palliative Care, Hamilton, ON, Canada
| | - Leonie Herx
- University of Calgary, Faculty of Medicine, Calgary, AB, Canada
| | | | - Christopher A Klinger
- McMaster University, Department of Family Medicine and Division of Palliative Care, Hamilton, ON, Canada
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Fasting A, Hetlevik I, Mjølstad BP. Put on the sidelines of palliative care: a qualitative study of important barriers to GPs' participation in palliative care and guideline implementation in Norway. Scand J Prim Health Care 2024; 42:254-265. [PMID: 38289262 PMCID: PMC11003325 DOI: 10.1080/02813432.2024.2306241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/11/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Demographic changes, the evolvement of modern medicine and new treatments for severe diseases, increase the need for palliative care services. Palliative care includes all patients with life-limiting conditions, irrespective of diagnosis. In Norway, palliative care rests on a decentralised model where patient care can be delivered close to the patient's home, and the Norwegian guideline for palliative care describes a model of care resting on extensive collaboration. Previous research suggests that this guideline is not well implemented among general practitioners (GPs). In this study, we aim to investigate barriers to GPs' participation in palliative care and implementation of the guideline. METHODS We interviewed 25 GPs in four focus groups guided by a semi-structured interview guide. The interviews were recorded and transcribed verbatim. Data were analysed qualitatively with reflexive thematic analysis. RESULTS We identified four main themes as barriers to GPs' participation in palliative care and to implementation of the guideline: (1) different established local cultures and practices of palliative care, (2) discontinuity of the GP-patient relationship, (3) unclear clinical handover and information gaps and (4) a mismatch between the guideline and everyday general practice. CONCLUSION Significant structural and individual barriers to GPs' participation in palliative care exist, which hamper the implementation of the guideline. GPs should be involved as stakeholders when guidelines involving them are created. Introduction of new professionals in primary care needs to be actively managed to avoid inappropriate collaborative practices. Continuity of the GP-patient relationship must be maintained throughout severe illness and at end-of-life.
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Affiliation(s)
- Anne Fasting
- General Practice Research Unit, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Unit for Palliative Care and Chemotherapy Treatment, Oncology Department, Møre og Romsdal Hospital Trust, Kristiansund Hospital, Norway
| | - Irene Hetlevik
- General Practice Research Unit, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Bente Prytz Mjølstad
- General Practice Research Unit, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Saksvik legekontor, Saxe Viks veg 4, N-7562 Hundhammeren, Norway
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3
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Chan WS, Funk L, Thompson G. A Social Capital Perspective on Social-Medical Collaboration in Community End-of-Life Care in Hong Kong. OMEGA-JOURNAL OF DEATH AND DYING 2024; 89:57-72. [PMID: 34991381 PMCID: PMC11017689 DOI: 10.1177/00302228211066678] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Recent developments in Hong Kong end-of-life (EOL) care have shifted some caring work for dying people and their families to cross-disciplinary collaboration in community settings. Social-medical collaboration becomes especially important. This study aims to use social capital as an analytical lens to examine the processes and mechanisms of social-medical collaboration in EOL care and elucidate practice implications for engaging in the care of dying people and their families. Qualitative data were collected using in-depth interviews. Three major conceptual categories were generated through grounded theory methodology. They are (a) establishing trust through keeping clear and simple boundaries, (b) cultivating mutuality in the multi-disciplinary meeting, and (c) fostering social-medical collaboration in EOL care. Each new stage is based on the social capital accumulated in the previous one through the social interactions between professionals. Such theorization also provides insights into how to achieve effective social-medical collaboration in this context.
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Affiliation(s)
- Wing-sun Chan
- Department of Sociology and Criminology, University of Manitoba, Winnipeg, MB, Canada
| | - Laura Funk
- Department of Sociology and Criminology, University of Manitoba, Winnipeg, MB, Canada
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Grant M, McCarthy D, Kearney C, Collins A, Sundararajan V, Rhee J, Philip J, Emery J. Primary care usage at the end of life: a retrospective cohort study of cancer patients using linked primary and hospital care data. Support Care Cancer 2024; 32:273. [PMID: 38587665 PMCID: PMC11001688 DOI: 10.1007/s00520-024-08458-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 03/25/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE Health service use is most intensive in the final year of a person's life, with 80% of this expenditure occurring in hospital. Close involvement of primary care services has been promoted to enhance quality end-of-life care that is appropriate to the needs of patients. However, the relationship between primary care involvement and patients' use of hospital care is not well described. This study aims to examine primary care use in the last year of life for cancer patients and its relationship to hospital usage. METHODS Retrospective cohort study in Victoria, Australia, using linked routine care data from primary care, hospital and death certificates. Patients were included who died related to cancer between 2008 and 2017. RESULTS A total of 758 patients were included, of whom 88% (n = 667) visited primary care during the last 6 months (median 9.1 consultations). In the last month of life, 45% of patients were prescribed opioids, and 3% had imaging requested. Patients who received home visits (13%) or anticipatory medications (15%) had less than half the median bed days in the last 3 months (4 vs 9 days, p < 0.001, 5 vs 10 days, p = 0.001) and 1 month of life (0 vs 2 days, p = 0.002, 0 vs 3 days, p < 0.001), and reduced emergency department presentations (32% vs 46%, p = 0.006, 31% vs 47% p < 0.001) in the final month. CONCLUSION This study identifies two important primary care processes-home visits and anticipatory medication-associated with reduced hospital usage and intervention at the end of life.
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Affiliation(s)
- M Grant
- Palliative Nexus Research Group, Department of Medicine, University of Melbourne, Melbourne, Australia.
- Department of Palliative Medicine, St Vincent's Hospital Melbourne, Melbourne, Australia.
- Centre of Expertise in Palliative Care Utrecht, Department of General Practice, Julius Centre, UMC Utrecht, Universiteitsweg 100, 3584CG, Utrecht, The Netherlands.
| | - D McCarthy
- Dept of General Practice and Primary Care, Centre for Cancer Research, University of Melbourne, Melbourne, Australia
| | - C Kearney
- Dept of General Practice and Primary Care, Centre for Cancer Research, University of Melbourne, Melbourne, Australia
| | - A Collins
- Palliative Nexus Research Group, Department of Medicine, University of Melbourne, Melbourne, Australia
- Department of Palliative Medicine, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - V Sundararajan
- La Trobe University, Public Health, Melbourne, Australia
| | - J Rhee
- Discipline of General Practice, School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
| | - J Philip
- Palliative Nexus Research Group, Department of Medicine, University of Melbourne, Melbourne, Australia
- Department of Palliative Medicine, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - J Emery
- Centre of Expertise in Palliative Care Utrecht, Department of General Practice, Julius Centre, UMC Utrecht, Universiteitsweg 100, 3584CG, Utrecht, The Netherlands
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Peter S, Volkert AM, Radbruch L, Rolke R, Voltz R, Pfaff H, Scholten N. Influence of Palliative Care Qualifications on the Job Stress Factors of General Practitioners in Palliative Care: A Survey Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14541. [PMID: 36361420 PMCID: PMC9655917 DOI: 10.3390/ijerph192114541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/24/2022] [Accepted: 11/03/2022] [Indexed: 06/16/2023]
Abstract
Due to demographic change, the number of patients in palliative care (PC) is increasing. General Practitioners (GPs) are important PC providers who often have known their patients for a long time. PC can be demanding for GPs. However, there are few studies on the job stress factors of GPs performing PC and the potential influence of their PC training. To get more insights, a postal survey was performed with GPs in North Rhine, Germany. The questionnaire was based on a literature search, qualitative pre-studies, and the Hospital Consultants' Job Stress & Satisfaction Questionnaire (HCJSSQ). Participants state that a high level of responsibility, conflicting demands, and bureaucracy are the most important stressors they experienced in PC. The influence of PC qualification level on their perceived job stress factors is low. Only advanced but not specialist qualification shows a correlation with renumeration-related stress. Gender and work experience are more dominant influences. In our study, female GPs and physicians with more work experience tend to be more stressed. In conclusion, organisational barriers, such as administration, should be reduced and renumeration should be increased to facilitate the daily work of GPs.
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Affiliation(s)
- Sophie Peter
- Faculty of Human Sciences, University of Cologne, 50933 Cologne, Germany
- Faculty of Medicine, University of Cologne, 50933 Cologne, Germany
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science, University Hospital Cologne, 50933 Cologne, Germany
| | - Anna Maria Volkert
- Faculty of Human Sciences, University of Cologne, 50933 Cologne, Germany
- Faculty of Medicine, University of Cologne, 50933 Cologne, Germany
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science, University Hospital Cologne, 50933 Cologne, Germany
| | - Lukas Radbruch
- Department of Palliative Medicine, University Hospital Bonn, 53127 Bonn, Germany
| | - Roman Rolke
- Department of Palliative Medicine, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany
| | - Raymond Voltz
- Faculty of Medicine, University of Cologne, 50933 Cologne, Germany
- Department of Palliative Medicine, University Hospital Cologne, 50933 Cologne, Germany
- CIO Aachen Bonn Cologne Düsseldorf, 50937 Cologne, Germany
| | - Holger Pfaff
- Faculty of Human Sciences, University of Cologne, 50933 Cologne, Germany
- Faculty of Medicine, University of Cologne, 50933 Cologne, Germany
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science, University Hospital Cologne, 50933 Cologne, Germany
| | - Nadine Scholten
- Faculty of Human Sciences, University of Cologne, 50933 Cologne, Germany
- Faculty of Medicine, University of Cologne, 50933 Cologne, Germany
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science, University Hospital Cologne, 50933 Cologne, Germany
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Atreya S, Datta SS, Salins N. Views of general practitioners on end-of-life care learning preferences: a systematic review. BMC Palliat Care 2022; 21:162. [PMID: 36127706 PMCID: PMC9490975 DOI: 10.1186/s12904-022-01053-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 09/12/2022] [Indexed: 11/16/2022] Open
Abstract
Background General practitioners (GPs) play a pivotal role in providing end-of-life care in the community. Although they value end-of-life care, they have apprehensions about providing care in view of the limitations in knowledge and skills in end-of-life care. This review aimed to explore, synthesise, and analyse the views of general practitioners on end-of-life care learning preferences. Methods MEDLINE, CINAHL, PsycINFO, EMBASE, Scopus, Web of Science, and Cochrane were searched for literature on the views of general practitioners on end-of-life care learning preferences from 01/01/1990 to 31/05/2021. Methodological quality was reported. Results Of the 10,037 articles identified, 23 were included for the review. Five themes developed from the review. The desire to provide palliative care, as well as self-actualisation needs, relevance to practice, a sense of responsibility, and a therapeutic bond, motivates general practitioners to learn end-of-life care. Some of the learning needs expressed were pain and symptom management, communication skills, and addressing caregiver needs. Experiential learning and pragmatist learning styles were preferred learning styles. They perceived the need for an amicable learning environment in which they could freely express their deficiencies. The review also identified barriers to learning, challenges at personal and professional level, feelings of disempowerment, and conflicts in care. Conclusion GPs’ preference for learning about end-of-life care was influenced by the value attributed to learning, context and content, as well as preference for learning styles and the availability of resources. Thus, future trainings must be in alignment with the GPs’ learning preferences. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-01053-9.
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Affiliation(s)
- Shrikant Atreya
- Department of Palliative Care and Psychooncology, Tata Medical Center, Kolkata, West Bengal, 700160, India
| | - Soumitra S Datta
- Department of Palliative Care and Psychooncology, Tata Medical Center, Kolkata, West Bengal, 700160, India.,Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Naveen Salins
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India.
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Weller D. Improving cancer outcomes in Asia: Can primary care take the lead? Eur J Cancer Care (Engl) 2022; 31:e13693. [PMID: 36089811 DOI: 10.1111/ecc.13693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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An ethnographic evaluation of a speciality training pathway for general practice nursing in the UK. Nurse Educ Pract 2022; 62:103347. [DOI: 10.1016/j.nepr.2022.103347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 02/02/2022] [Accepted: 03/29/2022] [Indexed: 11/21/2022]
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Robinson J, Frey R, Raphael D, Old A, Gott M. Difficulties in navigating the intersection of generalist and specialist palliative care services: A cross-sectional study of bereaved family's experiences of care at home in New Zealand. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:133-141. [PMID: 33894085 DOI: 10.1111/hsc.13381] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 03/09/2021] [Accepted: 03/15/2021] [Indexed: 06/12/2023]
Abstract
A generalist-specialist model of palliative care is well established as a framework for the provision of community care in resource-rich countries. However, evidence is lacking regarding how the model is experienced by family carers and the extent to which access to both generalist and specialist palliative care is equitable. A cross-sectional postal survey was undertaken to explore bereaved family's experiences of generalist palliative care and its intersection with hospice services in the last 3 months of life. A modified version of the Views of Informal Carers-Evaluation of Services survey was sent to 4,778 bereaved family. Data were collected between February 2017 and October 2018. Chi-square was utilised to identify factors that impacted on experiences of generalist palliative care; analysis of free text data comprising 45,823 words was undertaken using a directed content analysis approach. Eight hundred and twenty-six questionnaires were returned (response rate = 21%). Seventy per cent of people (n = 579) spent some time at home in the last 3 months prior to death. People who received support from hospice were more likely to receive support from multiple other services. Those who received no community services were less likely to feel supported by their general practitioner, less likely to spend the last 2 days of life or die at home. Feeling supported had a strong association with services working well together, being involved in decision-making and being aware of the poor prognosis. The provision of palliative care is complicated by a lack of integration with specialist palliative care and may be the basis of continuing inequities in the provision of community care at the end of life. The assumption at a policy level that "generalists" are willing and able to play a key role in palliative care provision needs to be further challenged.
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Affiliation(s)
- Jackie Robinson
- School of Nursing, University of Auckland, Auckland, New Zealand
- Auckland District Health Board, Auckland, New Zealand
| | - Rosemary Frey
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Deborah Raphael
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Andrew Old
- Waitemata District Health Board, Auckland, New Zealand
| | - Merryn Gott
- School of Nursing, University of Auckland, Auckland, New Zealand
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Out-of-hours services and end-of-life hospital admissions: a complex intervention systematic review and narrative synthesis. Br J Gen Pract 2021; 71:e780-e787. [PMID: 34489250 PMCID: PMC8436777 DOI: 10.3399/bjgp.2021.0194] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/11/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Out-of-hours (OOH) hospital admissions for patients receiving end-of-life care are a common cause of concern for patients, families, clinicians, and policymakers. It is unclear what issues, or combinations of issues, lead OOH clinicians to initiate hospital care for these patients. AIM To investigate the circumstances, processes, and mechanisms of UK OOH services-initiated end-of-life care hospital admissions. DESIGN AND SETTING Systematic literature review and narrative synthesis. METHOD Eight electronic databases were searched from inception to December 2019 supplemented by hand-searching of the British Journal of General Practice. Key search terms included: 'out-of-hours services', 'hospital admissions', and 'end-of-life care'. Two reviewers independently screened and selected articles, and undertook quality appraisal using Gough's Weight of Evidence framework. Data was analysed using narrative synthesis and reported following PRISMA Complex Intervention guidance. RESULTS Searches identified 20 727 unique citations, 25 of which met the inclusion criteria. Few studies had a primary focus on the review questions. Admissions were instigated primarily to address clinical needs, caregiver and/or patient distress, and discontinuity or unavailability of care provision, and they were arranged by a range of OOH providers. Reported frequencies of patients receiving end-of-life care being admitted to hospital varied greatly; most evidence related to cancer patients. CONCLUSION Although OOH end-of-life care can often be readily resolved by hospital admissions, it comes with multiple challenges that seem to be widespread and systemic. Further research is therefore necessary to understand the complexities of OOH services-initiated end-of-life care hospital admissions and how the challenges underpinning such admissions might best be addressed.
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Mitchell G, Melaku M, Moss A, Chaille G, Makoni B, Lewis L, Mutch A. Evaluation of a commissioned end-of-life care service in Australian aged care facilities. PROGRESS IN PALLIATIVE CARE 2021. [DOI: 10.1080/09699260.2021.1905146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Geoffrey Mitchell
- Faculty of Medicine, The University of Queensland, Herston, Australia
| | - Megdelawit Melaku
- Faculty of Medicine, The University of Queensland, Herston, Australia
| | | | | | | | | | - Allyson Mutch
- Faculty of Medicine, The University of Queensland, Herston, Australia
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Damarell RA, Morgan DD, Tieman JJ, Healey D. Bolstering General Practitioner Palliative Care: A Critical Review of Support Provided by Australian Guidelines for Life-Limiting Chronic Conditions. Healthcare (Basel) 2020; 8:healthcare8040553. [PMID: 33322394 PMCID: PMC7763828 DOI: 10.3390/healthcare8040553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 12/07/2020] [Accepted: 12/10/2020] [Indexed: 02/06/2023] Open
Abstract
General practitioners (GPs) are increasingly expected to provide palliative care as ageing populations put pressure on specialist services. Some GPs, however, cite barriers to providing this care including prognostication challenges and lack of confidence. Palliative care content within clinical practice guidelines might serve as an opportunistic source of informational support to GPs. This review analysed palliative care content within Australian guidelines for life-limiting conditions to determine the extent to which it might satisfy GPs’ stated information needs and support them to provide quality end-of-life care. Six databases and guideline repositories were searched (2011–2018). Eligible guidelines were those for a GP audience and explicitly based on an appraisal of all available evidence. Content was mapped against an established palliative care domain framework (PEPSI-COLA) and quality was assessed using AGREE-II. The nine guidelines meeting inclusion criteria were heterogenous in scope and depth of palliative care domain coverage. The ‘communication’ needs domain was best addressed while patient physical and emotional needs were variably covered. Spiritual, out-of-hours, terminal care and aftercare content was scant. Few guidelines addressed areas GPs are known to find challenging or acknowledged useful decision-support tools. A template covering important domains might reduce content variability across guidelines.
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Affiliation(s)
- Raechel A. Damarell
- Research Centre for Palliative Care, Death and Dying, College of Nursing and Health Sciences, Flinders University, Adelaide 5001, Australia; (D.D.M.); (J.J.T.)
- Correspondence: ; Tel.: +61-8-7221-8887
| | - Deidre D. Morgan
- Research Centre for Palliative Care, Death and Dying, College of Nursing and Health Sciences, Flinders University, Adelaide 5001, Australia; (D.D.M.); (J.J.T.)
- Palliative and Supportive Services, College of Nursing and Health Sciences, Flinders University, Adelaide 5001, Australia;
| | - Jennifer J. Tieman
- Research Centre for Palliative Care, Death and Dying, College of Nursing and Health Sciences, Flinders University, Adelaide 5001, Australia; (D.D.M.); (J.J.T.)
| | - David Healey
- Palliative and Supportive Services, College of Nursing and Health Sciences, Flinders University, Adelaide 5001, Australia;
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Mitchell G, Murray SA. Supportive and palliative care in the age of deferred death: primary care's central role. BMJ Support Palliat Care 2020; 11:398-400. [PMID: 32973109 DOI: 10.1136/bmjspcare-2020-002616] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 01/16/2023]
Affiliation(s)
- Geoffrey Mitchell
- Mayne Academy of General Practice, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Scott A Murray
- Centre for Population Health Sciences, Usher Institute of Population Health Sciences and Informatics, Primary Palliative Care Research Group, The University of Edinburgh, Edinburgh, UK
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Mitchell G, Aubin M, Senior H, Johnson C, Fallon-Ferguson J, Williams B, Monterosso L, Rhee JJ, McVey P, Grant M, Nwachukwu H, Yates P. General practice nurses and physicians and end of life: a systematic review of models of care. BMJ Support Palliat Care 2020:bmjspcare-2019-002114. [PMID: 32718955 DOI: 10.1136/bmjspcare-2019-002114] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 04/28/2020] [Accepted: 06/02/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND General practitioners (GPs) and general practice nurses (GPNs) face increasing demands to provide palliative care (PC) or end-of-life care (EoLC) as the population ages. In order to maximise the impact of GPs and GPNs, the impact of different models of care that have been developed to support their practice of EoLC needs to be understood. OBJECTIVE To examine published models of EoLC that incorporate or support GP and GPN practice, and their impact on patients, families and the health system. METHOD Systematic literature review. Data included papers (2000 to 2017) sought from Medline, Psychinfo, Embase, Joanna Briggs Institute and Cochrane databases. RESULTS From 6209 journal articles, 13 papers reported models of care supporting the GP and GPN's role in EoLC or PC practice. Services and guidelines for clinical issues have mixed impact on improving symptoms, but improved adherence to clinical guidelines. National Frameworks facilitated patients being able to die in their preferred place. A single specialist PC-GP case conference reduced hospitalisations, better maintained functional capacity and improved quality of life parameters in both patients with cancer and without cancer. No studies examined models of care aimed at supporting GPNs. CONCLUSIONS Primary care practitioners have a natural role to play in EoLC, and most patient and health system outcomes are substantially improved with their involvement. Successful integrative models need to be tested, particularly in non-malignant diseases. Such models need to be explored further. More work is required on the role of GPNs and how to support them in this role.
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Affiliation(s)
- Geoffrey Mitchell
- Primary Care Clinical Unit, University of Queensland, Herston, Queensland, Australia
| | - Michèle Aubin
- Département de médecine familiale et de médecine d'urgence, Faculté de médecine, Université Laval, Quebec City, Quebec, Canada
| | - Hugh Senior
- Primary Care Clinical Unit, University of Queensland, Herston, Queensland, Australia
- College of Health, Massey University, Auckland, New Zealand
| | - Claire Johnson
- Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
- Medical School, The University of Western Australia, Crawley, Western Australia, Australia
| | - Julia Fallon-Ferguson
- Primary Care Collaborative Cancer Clinical Trials Group, The University of Melbourne, Melbourne, Victoria, Australia
- General Practice, University of Western Australia, Perth, Western Australia, Australia
| | - Briony Williams
- Primary Care Collaborative Cancer Clinical Trials Group, The University of Melbourne, Melbourne, Victoria, Australia
- General Practice, University of Western Australia, Perth, Western Australia, Australia
| | - Leanne Monterosso
- School of Nursing, Notre Dame University, Perth, Western Australia, Australia
- School of Nursing, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Joel J Rhee
- General Practice Unit, University of Wollongong, Wollongong, New South Wales, Australia
| | - Peta McVey
- Susan Wakil School of Nursing, University of Sydney, Sydney, New South Wales, Australia
| | - Matthew Grant
- School of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Harriet Nwachukwu
- Primary Care Clinical Unit, University of Queensland, Herston, Queensland, Australia
| | - Patsy Yates
- Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
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