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

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Barriers to GPs identifying patients at the end-of-life and discussions about their care : a qualitative study. / Pocock, Lucy V.; Wye, Lesley; French, Lydia R.M.; Purdy, Sarah.

In: Family Practice, Vol. 36, No. 5, 01.10.2019, p. 639-643.

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@article{b707d67360974c0e8a57c902f474a08c,
title = "Barriers to GPs identifying patients at the end-of-life and discussions about their care: a qualitative study",
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 andanalysed 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 = "advanced care planning, family practice, general practice, palliative care, primary health care, terminal care",
author = "Pocock, {Lucy V.} and Lesley Wye and French, {Lydia R.M.} and Sarah Purdy",
year = "2019",
month = "10",
day = "1",
doi = "10.1093/fampra/cmy135",
language = "English",
volume = "36",
pages = "639--643",
journal = "Family Practice",
issn = "0263-2136",
publisher = "Oxford University Press",
number = "5",

}

RIS - suitable for import to EndNote

TY - JOUR

T1 - Barriers to GPs identifying patients at the end-of-life and discussions about their care

T2 - a qualitative study

AU - Pocock, Lucy V.

AU - Wye, Lesley

AU - French, Lydia R.M.

AU - Purdy, Sarah

PY - 2019/10/1

Y1 - 2019/10/1

N2 - 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 andanalysed 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.

AB - 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 andanalysed 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.

KW - advanced care planning

KW - family practice

KW - general practice

KW - palliative care

KW - primary health care

KW - terminal care

UR - http://www.scopus.com/inward/record.url?scp=85073058233&partnerID=8YFLogxK

U2 - 10.1093/fampra/cmy135

DO - 10.1093/fampra/cmy135

M3 - Article

VL - 36

SP - 639

EP - 643

JO - Family Practice

JF - Family Practice

SN - 0263-2136

IS - 5

ER -