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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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Abstract
BACKGROUND Building palliative care capacity among all healthcare practitioners caring for patients with chronic illnesses, who do not work in specialist palliative care services (non-specialist palliative care), is fundamental in providing more responsive and sustainable palliative care. Varying terminology such as 'generalist', 'basic' and 'a palliative approach' are used to describe this care but do not necessarily mean the same thing. Internationally, there are also variations between levels of palliative care which means that non-specialist palliative care may be applied inconsistently in practice because of this. Thus, a systematic exploration of the concept of non-specialist palliative care is warranted. AIM To advance conceptual, theoretical and operational understandings of and clarity around the concept of non-specialist palliative care. DESIGN The principle-based method of concept analysis, from the perspective of four overarching principles, such as epistemological, pragmatic, logical and linguistic, were used to analyse non-specialist palliative care. DATA SOURCES The databases of CINAHL, PubMed, PsycINFO, The Cochrane Library and Embase were searched. Additional searches of grey literature databases, key text books, national palliative care policies and websites of chronic illness and palliative care organisations were also undertaken. CONCLUSION Essential attributes of non-specialist palliative care were identified but were generally poorly measured and understood in practice. This concept is strongly associated with quality of life, holism and patient-centred care, and there was blurring of roles and boundaries particularly with specialist palliative care. Non-specialist palliative care is conceptually immature, presenting a challenge for healthcare practitioners on how this clinical care may be planned, delivered and measured.
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Affiliation(s)
- Mary Nevin
- School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, Ireland
| | - Valerie Smith
- School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, Ireland
| | - Geralyn Hynes
- School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, Ireland
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Connell T, Griffiths R, Fernandez RS, Tran D, Agar M, Harlum J. Quality-of-life trajectory of clients and carers referred to a community palliative care service. Int J Palliat Nurs 2011; 17:80-5. [PMID: 21378692 DOI: 10.12968/ijpn.2011.17.2.80] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Palliative care clients often have a reduced quality of life (QOL). The purpose of this study was to explore the QOL trajectory of clients and carers newly referred to a community palliative care service. A total of 49 clients and 43 carers respectively completed the McGill QOL scale (MQOL) and the caregiver QOL cancer scale (CQOLC) questionnaires. Baseline data relating to demographics, health status, and QOL are presented for the 49 participants and their 43 carers, and these are compared with follow-up data from 22 clients and 13 carers (matched pairs). On average, there were no significant differences between baseline and follow-up QOL scores in any respects for either clients or carers, including measures of burden, disruptiveness, positive adaptation, and financial concerns. Whether this indicates that the care administered succeeded in cancelling out the worsening of the clients' conditions or whether it indicates a shortcoming of the care was not assessed.
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Connell T, Fernandez RS, Griffiths R, Tran D, Agar M, Harlum J, Langdon R. Perceptions of the impact of health-care services provided to palliative care clients and their carers 274. Int J Palliat Nurs 2010; 16:274-84. [PMID: 20925290 DOI: 10.12968/ijpn.2010.16.6.48829] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Ritin S Fernandez
- School of Nursing and Midwifery, College of Health and Science, University of Western Sydney
| | - Rhonda Griffiths
- Centre for Applied Nursing Research, Sydney South West Area Health Service
| | - Duong Tran
- Centre for Applied Nursing Research, Sydney South West Area Health Service
| | - Meera Agar
- Staff Specialist Palliative Medicine, Braeside Hospital, New South Wales, New South Wales
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