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Barriers to GPs identifying patients at the end-of-life and discussions about their care: a qualitative study

Research output: Contribution to journalArticle

Original languageEnglish
Pages (from-to)639-643
Number of pages5
JournalFamily Practice
Issue number5
Early online date14 Jan 2019
DateAccepted/In press - 20 Dec 2018
DateE-pub ahead of print - 14 Jan 2019
DatePublished (current) - 1 Oct 2019


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.

    Research areas

  • advanced care planning, family practice, general practice, palliative care, primary health care, terminal care

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    Rights statement: This is the accepted author manuscript (AAM). The final published version (version of record) is available online via Oxford University Press at . Please refer to any applicable terms of use of the publisher.

    Accepted author manuscript, 255 KB, PDF document


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