What helps or hinders the communication of poor prognosis between secondary and primary care? A systematic review with narrative synthesis

Introduction
The communication of poor prognosis from secondary to primary care helps to ensure that patients with life-limiting illness receive appropriate, coordinated care in line with their preferences. However, little is known about this information-sharing process.

Aim
To determine how poor prognosis is communicated from secondary care to primary care.

Design and setting
Systematic literature review and narrative synthesis.

Method
Four electronic databases were searched from 1st January 2000 to 17th May 2021, supplemented by hand-searching key journals. One quarter of titles and abstracts were independently screened by a second reviewer. Two reviewers undertook data extraction and quality appraisal, independently using the Mixed-Methods Appraisal Tool. Data were analysed using narrative synthesis. Reporting follows PRISMA guidance.

Results
Searches identified 23,853 unique studies of which 30 met the inclusion criteria. Few studies had a focus on the interprofessional communication of poor prognosis. Information about prognosis was not commonly communicated from secondary to primary care and was more likely to occur if death was imminent. Lack of identification of poor prognosis by secondary care teams was a barrier. Facilitators included shared electronic records and direct clinician-clinician contact. GPs welcomed this information from secondary care and felt it was vital for continuity of care.

Conclusion
Although the communication of poor prognosis from secondary to primary care is highly valued, it is rare and associated with cultural and systemic challenges. Further research is necessary to understand the information needs of GPs and to explore the challenges facing secondary care clinicians initiating this communication.