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Niaré D, Robert G, Rocquevieille A, De Geyer L, Frin M, Pennec S, Hanslik T, Blanchon T, Rossignol L, Morel V. General practitioners and palliative care practices: a better knowledge of specific services is still needed. BMC Health Serv Res 2024; 24:832. [PMID: 39044274 PMCID: PMC11264423 DOI: 10.1186/s12913-024-11266-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 07/01/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND France allows deep sedation for pain relief, but not for euthanasia. In anticipation of an increase in home-based palliative care, the role of general practitioners is central to the design of outpatient palliative care services. This study aimed to describe the knowledge, attitudes, and practices of general practitioners in mainland France regarding palliative and end of life care. METHODS This was a national descriptive cross-sectional study within the Sentinelles network. Self-report questionnaires were distributed to general practitioners between November 2020 and November 2021. A descriptive analysis was carried out. RESULTS Out of the 123 participating general practitioners, 84% had received academic training in palliative care (n = 104). While a significant majority (69%) expressed comfort in pain management, only a quarter (25%) declared that they were competent at indicating deep and continuous sedation for pain relief. Awareness of outpatient palliative care facilities close to their place of practice such as hospitalization at home was over 97% (n = 117/120). Awareness of hospital facilities, including identified palliative care beds on hospital wards and palliative care units, was lower (75% (n = 59/79) and 86% (n = 86/100), respectively). CONCLUSIONS Our results suggest that French general practitioners are reasonably aware of palliative care resources available. However, there is room for improvement, particularly in understanding hospital-based facilities. Furthermore, a quarter of the general practitioners expressed discomfort with deep and continuous sedation for pain relief, highlighting the need for increased training in this specific aspect of palliative and end of life care.
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Affiliation(s)
- Daouda Niaré
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, F-75012, Paris, France.
| | - Guillaume Robert
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, F-75012, Paris, France
- Centre Hospitalier Universitaire (CHU) de Rennes, Service de soins palliatifs, 35033, Rennes Cedex, France
- Université Rennes 1, Rennes, France
| | | | | | | | - Sophie Pennec
- Institut National d'études Démographiques (INED), F-93320, Aubervilliers, France
- School of Demography, Australian National University, Canberra, Australia
| | - Thomas Hanslik
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, F-75012, Paris, France
- UFR des sciences de la santé Simone-Veil, Université de Versailles Saint-Quentin-en-Yvelines, F-78180, Montigny-le-Bretonneux, France
- Service de médecine interne, Hôpital Ambroise-Paré, Assistance publique-Hôpitaux de Paris, AP-HP, F-92100, Boulogne Billancourt, France
| | - Thierry Blanchon
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, F-75012, Paris, France
| | - Louise Rossignol
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, F-75012, Paris, France
- Département de Médecine Générale, Université Paris Cité, F-75018, Paris, France
| | - Vincent Morel
- Centre Hospitalier Universitaire (CHU) de Rennes, Service de soins palliatifs, 35033, Rennes Cedex, France
- Université Rennes 1, Rennes, France
- Université de Rennes, INSERM, Centre d'investigation clinique de Rennes (CIC 1414), 35000, Rennes, France
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Balasundram S, Holm A, Benthien KS, Waldorff FB, Reventlow S, Overbeck G. Increasing the chance of dying at home: roles, tasks and approaches of general practitioners enabling palliative care: a systematic review of qualitative literature. BMC PRIMARY CARE 2023; 24:77. [PMID: 36959553 PMCID: PMC10035229 DOI: 10.1186/s12875-023-02038-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 03/15/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Many elderly people wish to die at home but end up dying at the hospital. If the patient wishes to die at home, palliative care provided by General Practitioners (GPs) may increase the chance of dying at home, however, there is a lack of knowledge on how GPs should provide palliative care. We aimed to identify roles, tasks and approaches of GPs enabling palliative care, by exploring the experiences of GPs, other healthcare professionals, patients, and relatives through a systematic review of the qualitative literature. METHODS We searched PubMed, EMBASE, PsycINFO, Web of Science, and CINAHL in March 2022. Thematic analysis was used for synthesizing the results. RESULTS Four thousand five hundred sixty three unique records were retrieved, and 12 studies were included for review. Of these, ten were interview or focus group studies and two were survey studies with additional open-ended questions. Only qualitative findings from the studies were used in synthesizing the results. Thematic analysis produced four main themes describing the roles, tasks and approaches of GPs enabling palliative care to increase the chance for patients to die at home. GPs can support patients in the final phases of life by applying a holistic, patient-centred, and proactive approach to palliative care and by having sufficient education and training. Furthermore, the palliative care consultation should include symptom management, handling psychosocial and spiritual needs, maintaining a fragile balance, and proper communication with the patient. Lastly, GPs must address several palliative care elements surrounding the consultation including initiating the palliative care, being available, being the team coordinator/collaborator, providing continuous care and having sufficient knowledge about the patient. CONCLUSIONS The roles, tasks and approaches of the GPs enabling palliative care include being aware of elements in the palliative care consultation and elements surrounding the consultation and by having sufficient education and training and a broad, proactive, and patient-centred approach.
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Affiliation(s)
- Shangavi Balasundram
- The Research Unit for General Practice and Section for General Practice, University of Copenhagen, Copenhagen, Denmark.
| | - Anne Holm
- The Research Unit for General Practice and Section for General Practice, University of Copenhagen, Copenhagen, Denmark
| | | | - Frans Boch Waldorff
- The Research Unit for General Practice and Section for General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Reventlow
- The Research Unit for General Practice and Section for General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Gritt Overbeck
- The Research Unit for General Practice and Section for General Practice, University of Copenhagen, Copenhagen, Denmark
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Chen W, Chung JOK, Lam KKW, Molassiotis A. End-of-life communication strategies for healthcare professionals: A scoping review. Palliat Med 2023; 37:61-74. [PMID: 36349371 DOI: 10.1177/02692163221133670] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Timely and effective communication about end-of-life issues, including conversations about prognosis and goals of care, are extremely beneficial to terminally ill patients and their families. However, given the context, healthcare professionals may find it challenging to initiate and facilitate such conversations. Hence, it is critical to improving the available communication strategies to enhance end-of-life communication practices. AIM To summarise the end-of-life communication strategies recommended for healthcare professionals, identify research gaps and inform future research. DESIGN A scoping review performed in accordance with the Arksey and O'Malley framework. DATA SOURCES A literature search was conducted between January 1990 and January 2022 using PubMed, CINAHL, Embase, PsycINFO, Web of Science, Scopus, Cochrane Library and China National Knowledge Infrastructure databases and Google, Google Scholar and ProQuest Dissertations & Theses Global. Studies that described recommended end-of-life communication strategies for healthcare professionals were included. RESULTS Fifty-nine documents were included. Seven themes of communication strategies were found: (a) preparation; (b) exploration and assessment; (c) family involvement; (d) provision and tailoring of information; (e) empathic emotional responses; (f) reframing and revisiting the goals of care; and (g) conversation closure. CONCLUSIONS The themes of communication strategies found in this review provide a framework to integrally promote end-of-life communication. Our results will help inform healthcare professionals, thereby promoting the development of specialised training and education on end-of-life communication.
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Affiliation(s)
- Weilin Chen
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
| | - Joyce Oi Kwan Chung
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
| | - Katherine Ka Wai Lam
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
| | - Alex Molassiotis
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China.,Health and Social Care Research Centre, University of Derby, Derby, UK
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4
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Ding J, Licqurish S, Cook A, Ritson D, Masarei C, Chua D, Mitchell G, Johnson CE. Delivery and outcomes of end-of-life care in the Australian context: Experiences and reflections of general practitioners. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e5145-e5155. [PMID: 35916631 PMCID: PMC10087779 DOI: 10.1111/hsc.13931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 06/11/2022] [Accepted: 07/08/2022] [Indexed: 06/15/2023]
Abstract
Previous research on general practitioners' (GPs') involvement in end-of-life care has largely focused on a specific aspect of care or has provided broad overviews that failed to capture individual variations in patient management. This qualitative study aimed to explore Australian GPs' feedback and reflections on the individual-level care provided for patients in their last year of life. The findings of the study were drawn from a nation-wide survey of GPs' experiences in end-of-life care. We analysed responses from 63 GPs for 267 of the 272 reported deaths. Factors influencing delivery of optimal end-of-life care reported by GPs were categorised into four groups: patient-related factors, carer-related factors, interactions between GPs and patients/carer-related factors and broader health system issues. Each group included both barriers and facilitators. Our study highlighted importance of the emotional dimensions of therapeutic relationships with patients and their family, availability and capacity of family support and smooth communication and continuity of care between GPs and hospitals in delivery of optimal end-of-life care. Lack of these facilitators, misconceptions of palliative care and conflicts on implementing care plans among patients and their family tended to impede delivery of such care. On the basis of our findings in the present study and previous literature, we conclude that improved end-of-life care in general practice requires comprehensive approaches to supporting both the GP and family to provide care in patients' preferred place, such as enhanced palliative care training and improved availability of external support for GPs, higher levels of hospital-based services reaching into community settings and broader community-based resources for families beyond simply the healthcare system.
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Affiliation(s)
- Jinfeng Ding
- Xiangya School of NursingCentral South UniversityChangshaPeople's Republic of China
- School of Population and Global HealthThe University of Western AustraliaPerthAustralia
| | | | - Angus Cook
- School of Population and Global HealthThe University of Western AustraliaPerthAustralia
| | | | | | - David Chua
- Primary Care Clinical UnitThe University of QueenslandBrisbaneAustralia
| | - Geoffrey Mitchell
- Primary Care Clinical UnitThe University of QueenslandBrisbaneAustralia
| | - Claire E. Johnson
- Monash Nursing and MidwiferyMonash UniversityMelbourneAustralia
- Australian Health Services Research InstituteUniversity of WollongongWollongongAustralia
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van Gaans D, Erny-Albrecht K, Tieman J. Palliative Care Within the Primary Health Care Setting in Australia: A Scoping Review. Public Health Rev 2022; 43:1604856. [PMID: 36148429 PMCID: PMC9485459 DOI: 10.3389/phrs.2022.1604856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 08/19/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives: This scoping review identifies and details the scope of practice of health professionals who provide palliative care within the primary health setting in Australia.Methods: A scoping review approach was conducted on the Cinahl (Ebsco), Scopus, Medline (Ovid) and PubMed databases to extract articles from 1 December 2015 to 1 December 2020. Broad text words and MeSH headings were used with relevance to palliative care, general practice, primary health, and community setting. Extracted journal articles were limited to those based on the Australian population or Australian health system.Results: Eighty-four papers met the inclusion criteria and were included in the review. The review identified the following health professional roles within the Primary Health Care setting undertaking palliative care: General Practitioner, Nurse, Pharmacist, Paramedics, Carers, and Allied Health professionals.Conclusion: This review offers a first understanding of the individual health professional roles and multidisciplinary team approach to actively providing palliative care within the Primary Health Care setting in Australia.
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Ding J, Johnson CE, Saunders C, Licqurish S, Chua D, Mitchell G, Cook A. Provision of end-of-life care in primary care: a survey of issues and outcomes in the Australian context. BMJ Open 2022; 12:e053535. [PMID: 35046002 PMCID: PMC8772411 DOI: 10.1136/bmjopen-2021-053535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To describe general practitioners' (GPs) involvement in end-of-life care, continuity and outcomes of care, and reported management challenges in the Australian context. METHODS Sixty-three GPs across three Australian states participated in a follow-up survey to report on care provided for decedents in the last year life using a clinic-based data collection process. The study was conducted between September 2018 and August 2019. RESULTS Approximately one-third of GPs had received formal palliative care training. Practitioners considered themselves as either the primary care coordinator (53.2% of reported patients) or part of the management team (40.4% of reported patients) in the final year of care. In the last week of life, patients frequently experienced reduced appetite (80.6%), fatigue (77.9%) and psychological problems (44.9%), with GPs reporting that the alleviation of these symptoms were less than optimal. Practitioners were highly involved in end-of-life care (eg, home visits, consultations via telephone and family meetings), and perceived higher levels of satisfaction with communication with palliative care services than other external services. For one-third of patients, GPs reported that the last year of care could potentially have been improved. CONCLUSION There are continuing needs for integration of palliative care training into medical education and reforms of healthcare systems to further support GPs' involvement in end-of-life care. Further, more extensive collection of clinical data is needed to evaluate and support primary care management of end-of-life patients in general practice.
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Affiliation(s)
- Jinfeng Ding
- Xiangya School of Nursing, Central South University, Changsha, China
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Claire E Johnson
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
- Australian Health Service Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Christobel Saunders
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Sharon Licqurish
- School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
| | - David Chua
- Primary Care Clinical Unit, University of Queensland, Brisbane, Queensland, Australia
| | - Geoffrey Mitchell
- Primary Care Clinical Unit, University of Queensland, Brisbane, Queensland, Australia
| | - Angus Cook
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
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Bowers B, Pollock K, Barclay S. Unwelcome memento mori or best clinical practice? Community end of life anticipatory medication prescribing practice: A mixed methods observational study. Palliat Med 2022; 36:95-104. [PMID: 34493122 PMCID: PMC8796157 DOI: 10.1177/02692163211043382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Anticipatory medications are injectable drugs prescribed ahead of possible need for administration if distressing symptoms arise in the final days of life. Little is known about how they are prescribed in primary care. AIM To investigate the frequency, timing and recorded circumstances of anticipatory medications prescribing for patients living at home and in residential care. DESIGN Retrospective mixed methods observational study using General Practitioner and community nursing clinical records. SETTING/PARTICIPANTS 329 deceased adult patients registered with Eleven General Practitioner practices and two associated community nursing services in two English counties (30 most recent deaths per practice). Patients died from any cause except trauma, sudden death or suicide, between 4 March 2017 and 25 September 2019. RESULTS Anticipatory medications were prescribed for 167/329 (50.8%) of the deceased patients, between 0 and 1212 days before death (median 17 days). The likelihood of prescribing was significantly higher for patients with a recorded preferred place of death (odds ratio [OR] 34; 95% CI 15-77; p < 0.001) and specialist palliative care involvement (OR 7; 95% CI 3-19; p < 0.001). For 66.5% of patients (111/167) anticipatory medications were recorded as being prescribed as part of a single end-of-life planning intervention. CONCLUSION The variability in the timing of prescriptions highlights the challenges in diagnosing the end-of-life phase and the potential risks of prescribing far in advance of possible need. Patient and family views and experiences of anticipatory medication care, and their preferences for involvement in prescribing decision-making, warrant urgent investigation.
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Affiliation(s)
- Ben Bowers
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Kristian Pollock
- Nottingham Centre for the Advancement of Research into Supportive, Palliative and End of Life Care, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Stephen Barclay
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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8
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Ding J, Johnson CE, Auret K, Ritson D, Masarei C, Chua D, Licqurish S, Mitchell G, Cook A. Comparison of end-of-life care for people living in home settings versus residential aged care facilities: A nationwide study among Australian general practitioners. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:91-101. [PMID: 33825245 DOI: 10.1111/hsc.13375] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 10/30/2020] [Accepted: 02/23/2021] [Indexed: 06/12/2023]
Abstract
We have little knowledge of differences in end-of-life care between home settings and residential aged care facilities (RACFs) where people spend most of their last year of life. This study aimed to compare end-of-life care between home settings and RACFs from the perspective of Australian general practitioners (GPs). A descriptive study was conducted with 62 GPs from Western Australia, Queensland and Victoria. Participants were asked to provide reports on end-of-life care of decedents in their practice using a validated clinic-based data collection process developed by our team between September 2018 and August 2019. Of the 213 reported expected deaths, 66.2% mainly lived at home in the last year of life. People living at home were more likely to die at a younger age (median 77 vs. 88, p < 0.001), to be male (51.1% vs. 33.3%, p = 0.01) and to die of cancer (53.9% vs. 4.2%, p < 0.001) compared to those in RACFs. There were no significant differences between the two patient groups for seven out of the eight assessed symptoms, except nausea. GPs' perceived roles in caring for patients and levels of their involvement in provision of common palliative care services were comparable between the two groups. The usual accommodation setting was most frequently considered the preferred place of death in both groups. However, more home residents ended up dying in hospital compared to RACF residents. There were significantly higher frequencies of end-of-life discussions (ORs ranged 5.46-9.82 for all topic comparisons) with GPs associated with people living at home versus RACFs. One opportunity for improved care is through promoting greater involvement of GPs in end-of-life discussions with RACF residents and staff. In general, more Australians could potentially remain at home until death if provided with greater access to essential specialist palliative care services and supportive services in home settings.
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Affiliation(s)
- Jinfeng Ding
- Xiangya School of Nursing, Central South University, Changsha, China
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Claire E Johnson
- Palliative Care Outcomes Collaboration, University of Wollongong, Wollongong, NSW, Australia
- School of Nursing and Midwifery, Monash University, Melbourne, VIC, Australia
- Supportive and Palliative Care, Eastern Health, Melbourne, VIC, Australia
| | - Kirsten Auret
- Rural Clinical School of Western Australia, The University of Western Australia, Albany, WA, Australia
| | - Dianne Ritson
- The Val Lishman Health Foundation, Bunbury, WA, Australia
| | | | - David Chua
- Primary Care Clinical Unit, The University of Queensland, Brisbane, QLD, Australia
| | - Sharon Licqurish
- School of Nursing and Midwifery, Monash University, Melbourne, VIC, Australia
| | - Geoffrey Mitchell
- Primary Care Clinical Unit, The University of Queensland, Brisbane, QLD, Australia
| | - Angus Cook
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
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Rehner L, Moon K, Hoffmann W, van den Berg N. Continuity in palliative care - analysis of intersectoral palliative care based on routine data of a statutory health insurance. BMC Palliat Care 2021; 20:59. [PMID: 33849501 PMCID: PMC8045326 DOI: 10.1186/s12904-021-00751-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 04/06/2021] [Indexed: 11/28/2022] Open
Abstract
Background The goal of palliative care is to prevent and alleviate a suffering of incurable ill patients. A continuous intersectoral palliative care is important. The aim of this study is to analyse the continuity of palliative care, particularly the time gaps between hospital discharge and subsequent palliative care as well as the timing of the last palliative care before the patient’s death. Methods The analysis was based on claims data from a large statutory health insurance. Patients who received their first palliative care in 2015 were included. The course of palliative care was followed for 12 months. Time intervals between discharge from hospital and first subsequent palliative care as well as between last palliative care and death were analysed. The continuity in palliative care was defined as an interval of less than 14 days between palliative care. Data were analysed using descriptive statistics and Chi-Square. Results In 2015, 4177 patients with first palliative care were identified in the catchment area of the statutory health insurance. After general inpatient palliative care, 415 patients were transferred to subsequent palliative care, of these 67.7% (n = 281) received subsequent care within 14 days. After a stay in a palliative care ward, 124 patients received subsequent palliative care, of these 75.0% (n = 93) within 14 days. Altogether, 147 discharges did not receive subsequent palliative care. During the 12-months follow-up period, 2866 (68.7%) patients died, of these 78.7% (n = 2256) received palliative care within the last 2 weeks of life. Of these, 1223 patients received general ambulatory palliative care, 631 patients received specialised ambulatory palliative care, 313 patients received their last palliative care at a hospital and 89 patients received it in a hospice. Conclusions The majority of the palliative care patients received continuous palliative care. However, there are some patients who did not receive continuous palliative care. After inpatient palliative care, each patient should receive a discharge management for a continuation of palliative care. Readmissions of patients after discharge from inpatients palliative care can be an indication for a lack of support in the ambulatory health care setting and for an insufficient discharge management. Palliative care training and possibilities for palliative care consultations by specialists should strengthen the GPs in palliative care. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00751-0.
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Affiliation(s)
- Laura Rehner
- Department of Epidemiology and Community Health, Institute for Community Medicine, University Medicine Greifswald, Ellernholzstr. 1-2, 17489, Greifswald, Germany.
| | - Kilson Moon
- Department of Epidemiology and Community Health, Institute for Community Medicine, University Medicine Greifswald, Ellernholzstr. 1-2, 17489, Greifswald, Germany
| | - Wolfgang Hoffmann
- Department of Epidemiology and Community Health, Institute for Community Medicine, University Medicine Greifswald, Ellernholzstr. 1-2, 17489, Greifswald, Germany
| | - Neeltje van den Berg
- Department of Epidemiology and Community Health, Institute for Community Medicine, University Medicine Greifswald, Ellernholzstr. 1-2, 17489, Greifswald, Germany
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Bowers B, Barclay SS, Pollock K, Barclay S. GPs' decisions about prescribing end-of-life anticipatory medications: a qualitative study. Br J Gen Pract 2020; 70:e731-e739. [PMID: 32895243 PMCID: PMC7480177 DOI: 10.3399/bjgp20x712625] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 03/19/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND GPs have a central role in decisions about prescribing anticipatory medications to help control symptoms at the end of life. Little is known about GPs' decision-making processes in prescribing anticipatory medications, how they discuss this with patients and families, or the subsequent use of prescribed drugs. AIM To explore GPs' decision-making processes in the prescribing and use of anticipatory medications for patients at the end of life. DESIGN AND SETTING A qualitative interview study with GPs working in one English county. METHOD Semi-structured interviews were conducted with a purposive sample of 13 GPs. Interview transcripts were analysed inductively using thematic analysis. RESULTS Three themes were constructed from the data: something we can do, getting the timing right, and delegating care while retaining responsibility. Anticipatory medications were a tangible intervention GPs felt they could offer patients approaching death (something we can do). The prescribing of anticipatory medications was recognised as a harbinger of death for patients and their families. Nevertheless, GPs preferred to discuss and prescribe anticipatory medications weeks before death was expected whenever possible (getting the timing right). After prescribing medications, GPs relied on nurses to assess when to administer drugs and keep them updated about their use (delegating care while retaining responsibility). CONCLUSION GPs view anticipatory medications as key to symptom management for patients at the end of life. The drugs are often presented as a clinical recommendation to ensure patients and families accept the prescription. GPs need regular access to nurses and rely on their skills to administer drugs appropriately. Patients' and families' experiences of anticipatory medications, and their preferences for involvement in decision making, warrant urgent investigation.
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Affiliation(s)
- Ben Bowers
- Queen's Nurse, NIHR School for Primary Care Research PhD student
| | - Sam S Barclay
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge
| | - Kristian Pollock
- Nottingham Centre for the Advancement of Research into Supportive, Palliative and End of Life Care, School of Health Sciences, University of Nottingham, Nottingham
| | - Stephen Barclay
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge
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