Despite most deaths taking place in hospitals, the bulk of palliative and end of life care (PEoLC) is given in primary care settings, such as the home or residential aged care.
While key players in primary care include GPs, practice managers, practice nurses, and community care services, these personnel are not always included in multidisciplinary teams, which can impact quality of PEoLC. The Centre of Research Excellence in End of Life Care examines approaches to PEoLC by GPs.
The GP EoLC project looked at the ways GPs identify approaching end of life in their patients, how their practice changes, and the challenges they confronted. While many GPs provided some PEoLC, the willingness of GPs and their patients to discuss a poor prognosis varied considerably.
It’s been widely reported that limited time with an increasingly busy workload, reluctance in opiate prescribing, and constraints in reimbursement all present challenges to GPs’ involvement in PEoLC (Aldridge et al. 2016; Luckett et al. 2015; Mason et al. 2015; Murray et al. 2015).
A lack of regular patients requiring PEoLC also impacted GPs knowledge and confidence (Aldridge et al. 2016; Carmont et al. 2017; Murray et al. 2015; Rhee et al. 2008). It is clear that integrated models of PEoLC are most effective, where GPs and their interdisciplinary clinical partners communicate openly, share care pathways, have appropriate training, and are supported by viable funding models (Carmont et al. 2017; Mitchell et al. 2015).
It is in these collaborations where early identification of, and planning for PEoLC needs is communicated in a timely way to team members (Aldridge et al. 2016; Carmont et al. 2017) and where case conferencing can directly impact upon reducing care burden, preventable admissions to hospital and improved quality of life (Mitchell et al. 2008, 2014; Hollingworth et al. 2016).
References
- Aldridge, M.D., Hasselaar, J., Garralda, E., van der Eerden, M., Stevenson, D., McKendrick, K., et al. 2016. Education implementation, and policy barriers to greater integration of palliative care: A literature review. Palliat Med 30: 224-39.
- Carmont, S.A., Mitchell, G., Senior, H., Foster, M. 2017. Systematic review of the effectiveness, barriers and facilitators to general practitioner engagement with specialist secondary services in integrated palliative care. BMJ Support Palliat Care.
- Hollingworth, S., Zhang, J., Vaikuntam, B.P., Jackson, C., Mitchell, G. 2016. Case conference primary-secondary care planning at end of life can reduce the cost of hospitalisations. BMC Palliat Care 15: 84.
- Luckett, T., Phillips, J., Agar, M., Virdun, C., Green, A., Davidson, P.M. 2014. Elements of effective palliative care models: a rapid review. BMC Health Serv Res 14: 136.
- Mason, B., Buckingham, S., Finucane, A., Hutchison, P., Kendall, M., McCutcheon, H., et al. 2015. Improving primary palliative care in Scotland: lessons from a mixed methods study. BMC Fam Pract; 16: 176.
- Mitchell, G., Zhang, J., Burridge, L., Senior, H., Miller, E., Young, S., et al. 2014. Case conferences between general practitioners and specialist teams to plan end of life care of people with end stage heart failure and lung disease: an exploratory pilot study. BMC Palliat Care; 13: 24.
- Mitchell, G.K., Burridge, L., Zhang, J., Donald, M., Scott, I.A., Dart, J., et al. 2015. Systematic review of integrated models of healthcare delivered at the primary – secondary interface: how effective is it and what determines effectiveness? Australian Journal of Primary Health; 391-408.
- Mitchell, G.K., Del Mar, C.B., O’Rourke, P.K., Clavarino, A.M. 2008. Do case conferences between general practitioners and specialist palliative care services improve quality of life? A randomised controlled trial (ISRCTN 52269003). Palliat Med; 22: 904-12.
- Murray, S.A., Firth, A., Schneider, N., Van den Eynden, B., Gomez- Batiste, X., Brogaard, T., et al. 2015. Promoting palliative care in the community: production of the primary palliative care toolkit by the European Association of Palliative Care Taskforce in primary palliative care. Palliat Med; 29: 101-11.
- Rhee, J.J., Zwar, N., Vagholkar, S., Dennis, S., Broadbent, A.M., Mitchell, G. 2008. Attitudes and barriers to involvement in palliative care by Australian urban general practitioners. J Palliat Med; 11: 980-
By John Rosenberg
Dr John Rosenberg is a Research Fellow at NHMRC Centre for Research Excellence in End of Life Care and is also at Queensland University of Technology, Institute of Health and Biomedical Innovation
