Barriers to GPs identifying patients at the end-of-life and discussions about their care: a qualitative study
- 14 January 2019
- journal article
- research article
- Published by Oxford University Press (OUP) in Family Practice
- Vol. 36 (5), 639-643
- https://doi.org/10.1093/fampra/cmy135
Abstract
Background Identification of patients at the end-of-life is the first step in care planning and many general practices have Palliative Care Registers. There is evidence that these largely comprise patients with cancer diagnoses, but little is known about the identification process. Objective To explore the barriers that hinder GPs from identifying and registering patients on Palliative Care Registers. Methods An exploratory qualitative approach was undertaken using semi-structured interviews with GPs in South West England. GPs were asked about their experiences of identifying, registering and discussing end-of-life care with patients. Interviews were audio recorded, transcribed and analysed thematically. Results Most practices had a Palliative Care Register, which were mainly composed of patients with cancer. They reported identifying non-malignant patients at the end-of-life as challenging and were reluctant to include frail or elderly patients due to resource implications. GPs described rarely using prognostication tools to identify patients and conveyed that poor communication between secondary and primary care made prognostication difficult. GPs also detailed challenges around talking to patients about end-of-life care. Conclusions Palliative Care Registers are widely used by GPs for patients with malignant diagnoses, but seldom for other patients. The findings from our study suggest that this arises because GPs find prognosticating for patients with non-malignant disease more challenging. GPs would value better communication from secondary care, tools for prognostication and training in speaking with patients at the end-of-life enabling them to better identify non-malignant patients at the end-of-life.Keywords
Funding Information
- Severn Faculty RCGP
This publication has 17 references indexed in Scilit:
- Development and validation of an electronic frailty index using routine primary care electronic health record dataAge and Ageing, 2016
- Impact of the Marie Curie Cancer Care Delivering Choice Programme in Somerset and North Somerset on place of death and hospital usage: a retrospective cohort studyBMJ Supportive & Palliative Care, 2014
- Are UK primary care teams formally identifying patients for palliative care before they die?British Journal of General Practice, 2012
- Anticipatory care planning and integration: a primary care pilot study aimed at reducing unplanned hospitalisationBritish Journal of General Practice, 2012
- Perceived barriers and facilitators for general practitioner–patient communication in palliative care: A systematic reviewPalliative Medicine, 2011
- Living and dying with severe chronic obstructive pulmonary disease: multi-perspective longitudinal qualitative studyBMJ, 2011
- Recognising and managing key transitions in end of life careBMJ, 2010
- What progress has been made towards implementing national guidance on end of life care? A national survey of UK general practicesPalliative Medicine, 2009
- Improving generalist end of life care: national consultation with practitioners, commissioners, academics, and service user groupsBMJ, 2008
- Improving the delivery of palliative care in general practice: an evaluation of the first phase of the Gold Standards FrameworkPalliative Medicine, 2007