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Rhee JJ, Grant M, Senior H, Monterosso L, McVey P, Johnson C, Aubin M, Nwachukwu H, Bailey C, Fallon-Ferguson J, Yates P, Williams B, Mitchell G. Facilitators and barriers to general practitioner and general practice nurse participation in end-of-life care: systematic review. BMJ Support Palliat Care 2020:bmjspcare-2019-002109. [PMID: 32561549 DOI: 10.1136/bmjspcare-2019-002109] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 04/17/2020] [Accepted: 05/04/2020] [Indexed: 01/11/2023]
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. To enhance primary EoLC, the facilitators and barriers to their provision need to be understood. OBJECTIVE To provide a comprehensive description of the facilitators and barriers to GP and GPN provision of PC or EoLC. METHOD Systematic literature review. Data included papers (2000 to 2017) sought from Medline, PsycInfo, Embase, Joanna Briggs Institute and Cochrane databases. RESULTS From 6209 journal articles, 62 reviewed papers reported the GP's and GPN's role in EoLC or PC practice. Six themes emerged: patient factors; personal GP factors; general practice factors; relational factors; co-ordination of care; availability of services. Four specific settings were identified: aged care facilities, out-of-hours care and resource-constrained settings (rural, and low-income and middle-income countries). Most GPs provide EoLC to some extent, with greater professional experience leading to increased comfort in performing this form of care. The organisation of primary care at practice, local and national level impose numerous structural barriers that impede more significant involvement. There are potential gaps in service provision where GPNs may provide significant input, but there is a paucity of studies describing GPN routine involvement in EoLC. CONCLUSIONS While primary care practitioners have a natural role to play in EoLC, significant barriers exist to improved GP and GPN involvement in PC. More work is required on the role of GPNs.
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Affiliation(s)
- Joel J Rhee
- School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Matthew Grant
- School of Medicine, Monash University, Clayton, Victoria, Australia
| | - Hugh Senior
- College of Health Sciences, Massey University-Albany Campus, Auckland, New Zealand
| | - Leanne Monterosso
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
- School of Nursing, University of Notre Dame, Fremantly, Western Australia, Australia
| | - Peta McVey
- Susan Wakil School of Nursing, University of Sydney, Sydney, New South Wales, Australia
| | - Claire Johnson
- Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
- Cancer and Palliative Care Research and Evaluation Unit, School of Surgery, The University of Western Australia, Perth, Western Australia, Australia
| | - Michèle Aubin
- Département de médecine familiale et de médecine d'urgence, Laval University Faculty of Medicine, Quebec City, Quebec, Canada
| | - Harriet Nwachukwu
- Primary Care Clinical Unit, The University of Queensland Faculty of Medicine, Herston, Queensland, Australia
| | - Claire Bailey
- School of Medicine, University of Notre Dame, Sydney, New South Wales, Australia
| | - Julia Fallon-Ferguson
- General Practice, The University of Western Australia, Perth, Western Australia, Australia
- Primary Care Cancer Clinical Trials Collaborative, University of Melbourne, Melbourne, Victoria, Australia
| | - Patsy Yates
- Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Briony Williams
- General Practice, The University of Western Australia, Perth, Western Australia, Australia
- Primary Care Cancer Clinical Trials Collaborative, University of Melbourne, Melbourne, Victoria, Australia
| | - Geoffrey Mitchell
- Primary Care Clinical Unit, The University of Queensland Faculty of Medicine, Herston, Queensland, Australia
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Māori: living and dying with cardiovascular disease in Aotearoa New Zealand. Curr Opin Support Palliat Care 2019; 13:3-8. [PMID: 30431459 DOI: 10.1097/spc.0000000000000404] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This article provides an informed perspective on cardiovascular disease (CVD) and palliative care need among Māori New Zealanders. High Māori CVD risk factors will contribute to a sharp increase in older Māori deaths which has implications for health and palliative care service provision. RECENT FINDINGS CVD is New Zealand's leading cause of premature deaths and disability among Māori. A projected rise in older Māori deaths within the next 30 years will require increased palliative care. However, accessing palliative care and obtaining and understanding information can be challenging for families who are already often overburdened with high social and economic disadvantages. Meeting the high financial costs associated with end-of-life care make living with CVD challenging. Engaging with the health system's biomedical approach when holistic care is preferable can be a major barrier. SUMMARY Māori families provide the bulk of care at end-of-life, but they can become fatigued with the challenges that accompany long-term progressive illnesses, such as CVD. They are also burdened by the financial costs associated with end-of-life. It is often difficult for Māori to access palliative care and to obtain and understand information about the illness and treatment. Navigating an unfamiliar and complex health system, low health literacy among Māori and poor relationship building and communication skills of health professionals are significant barriers. Cultural safety training would help to increase health and cardiovascular professionals' cultural understanding of Māori and their holistic end-of-life preferences; this could go some way to strengthen rapport building and communication skills necessary for effective engagement and informational exchanges. Increasing the Māori palliative care workforce and introducing cultural safety training among health professionals could help to bridge the gap. A current study to gather traditional care customs and present these to whānau and the health and palliative care sectors in the form of an online resource could contribute to this decolonizing objective.
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Smeets M, Zervas S, Leben H, Vermandere M, Janssens S, Mullens W, Aertgeerts B, Vaes B. General practitioners' perceptions about their role in current and future heart failure care: an exploratory qualitative study. BMC Health Serv Res 2019; 19:432. [PMID: 31253146 PMCID: PMC6599228 DOI: 10.1186/s12913-019-4271-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 06/17/2019] [Indexed: 12/28/2022] Open
Abstract
Background A comprehensive disease management programme (DMP) with a central role for general practitioners (GPs) is needed to improve heart failure (HF) care. However, previous research has shown that GPs have mixed experiences with multidisciplinary HF care. Therefore, in this study, we explore the perceptions that GPs have regarding their role in current and future HF care, prior to the design of an HF disease management programme. Methods This was a qualitative semi-structured interview study with Belgian GPs until data saturation was reached. The QUAGOL method was used for data analysis. Results In general, GPs wanted to assume a central role in HF care. Current interdisciplinary collaboration with cardiologists was perceived as smooth, partly because of the ease of access. In contrast, due to less well-established communication and the variable knowledge of nurses regarding HF care, collaboration with home care nurses was perceived as suboptimal. With regard to the future organization of HF care, all GPs confirmed the need for a structured chronic care approach and envisioned this as a multidisciplinary care pathway: flexible, patient-centred, without additional administration and with appropriate delegation of some critical tasks, including education and monitoring. GPs considered all-round general practice nurses as the preferred partner to delegate tasks to in HF care and reported limited experience in collaborating with specialist HF nurses. Conclusion GPs expressed the need for a protocol-driven care pathway in chronic HF care. However, in contrast to the existing care trajectories, this pathway should be flexible, without additional administrative burdens and with a central role for GPs. Electronic supplementary material The online version of this article (10.1186/s12913-019-4271-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Miek Smeets
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33, blok j bus 7001, 3000, Leuven, Belgium.
| | - Sofia Zervas
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33, blok j bus 7001, 3000, Leuven, Belgium
| | - Hanne Leben
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33, blok j bus 7001, 3000, Leuven, Belgium
| | - Mieke Vermandere
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33, blok j bus 7001, 3000, Leuven, Belgium
| | - Stefan Janssens
- Department of Cardiovascular Diseases, Universitair Ziekenhuis Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Wilfried Mullens
- Biomedical Research Institute, Faculty of Medicine and Life Sciences, U Hasselt, Hasselt, Belgium.,Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Bert Aertgeerts
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33, blok j bus 7001, 3000, Leuven, Belgium
| | - Bert Vaes
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33, blok j bus 7001, 3000, Leuven, Belgium.,Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
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Fujita J, Fukui S, Ikezaki S, Otoguro C, Tsujimura M. Analysis of team types based on collaborative relationships among doctors, home-visiting nurses and care managers for effective support of patients in end-of-life home care. Geriatr Gerontol Int 2017; 17:1943-1950. [DOI: 10.1111/ggi.12998] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 11/12/2016] [Accepted: 12/07/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Junko Fujita
- Department of Community Health Nursing; Japanese Red Cross College of Nursing; Tokyo Japan
| | - Sakiko Fukui
- Department of Community Health Nursing; Japanese Red Cross College of Nursing; Tokyo Japan
| | - Sumie Ikezaki
- Health Administration in Nursing; Chiba University; Chiba Japan
| | - Chizuru Otoguro
- Department of Community Health Nursing; Japanese Red Cross College of Nursing; Tokyo Japan
| | - Mayuko Tsujimura
- Department of Visiting Nursing, Graduate School of Nursing; Chiba University; Chiba Japan
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Raphael D, Waterworth S, Gott M. Telephone communication between practice nurses and older patients with long term conditions - a systematic review. J Telemed Telecare 2016; 23:142-148. [PMID: 26787642 DOI: 10.1177/1357633x15625398] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background and aims Long term conditions are a significant health problem faced by older people worldwide. Telephone communication is often used to deliver health care to patients and is an important tool in improving access to care. Previous research has shown that primary health care nurses communicate with patients by telephone, but little is known about the way in which telephone communication can be used to benefit older patients with long term conditions. The aims of this review were to identify the range and scope of telephone use between practice nurses working in primary health care and older people with long term conditions, explore which elements of this communication has been successful, and determine whether older people see telephone communication as useful for their needs. Methods A systematic search of the literature was conducted through CINAHL, Medline, Web of Science and EMBASE between July and August 2015. Included were English language articles containing older adults, primary care nurses and both qualitative and quantitative designs. Results Five studies met the inclusion criteria. All were intervention studies, and none looked at routine telephone communication between nurse and patient. Most studies showed that telephone based interventions were successful in improving pre-determined disease-specific health indicators. Conclusions All telephone communication interventions in this review focused on a specific long term condition, which they aimed to help patients self-manage. While all studies' samples included older patients, they did not consider them separately in relation to the effectiveness of the intervention. What was also lacking was the patient perspective regarding effectiveness in all but one study.
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Affiliation(s)
- Deborah Raphael
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, New Zealand
| | - Susan Waterworth
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, New Zealand
| | - Merryn Gott
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, New Zealand
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Oishi A, Murtagh FEM. The challenges of uncertainty and interprofessional collaboration in palliative care for non-cancer patients in the community: a systematic review of views from patients, carers and health-care professionals. Palliat Med 2014; 28:1081-98. [PMID: 24821710 PMCID: PMC4232314 DOI: 10.1177/0269216314531999] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Primary care has the potential to play significant roles in providing effective palliative care for non-cancer patients. AIM To identify, critically appraise and synthesise the existing evidence on views on the provision of palliative care for non-cancer patients by primary care providers and reveal any gaps in the evidence. DESIGN Standard systematic review and narrative synthesis. DATA SOURCES MEDLINE, Embase, CINAHL, PsycINFO, Applied Social Science Abstract and the Cochrane library were searched in 2012. Reference searching, hand searching, expert consultations and grey literature searches complemented these. Papers with the views of patients/carers or professionals on primary palliative care provision to non-cancer patients in the community were included. The amended Hawker's criteria were used for quality assessment of included studies. RESULTS A total of 30 studies were included and represent the views of 719 patients, 605 carers and over 400 professionals. In all, 27 studies are from the United Kingdom. Patients and carers expect primary care physicians to provide compassionate care, have appropriate knowledge and play central roles in providing care. The roles of professionals are unclear to patients, carers and professionals themselves. Uncertainty of illness trajectory and lack of collaboration between health-care professionals were identified as barriers to effective care. CONCLUSIONS Effective interprofessional work to deal with uncertainty and maintain coordinated care is needed for better palliative care provision to non-cancer patients in the community. Research into and development of a best model for effective interdisciplinary work are needed.
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Affiliation(s)
- Ai Oishi
- Cicely Saunders Institute, King's College London, London, UK
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Waterworth S, Gott M, Raphael D, Parsons J, Arroll B. Working with older people with multiple long-term conditions: a qualitative exploration of nurses' experiences. J Adv Nurs 2014; 71:90-9. [DOI: 10.1111/jan.12474] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Susan Waterworth
- School of Nursing; Department of Medical and Health Sciences; University of Auckland; New Zealand
| | - Merryn Gott
- School of Nursing; University of Auckland; New Zealand
| | | | - John Parsons
- School of Nursing; University of Auckland; New Zealand
| | - Bruce Arroll
- School of Population Health; University of Auckland; New Zealand
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