An Insight Into the Delivery of a Palliative Approach in Residential Aged Care

Abstract

Managing the complex care needs of older people is a global concern. General practitioners (GPs) play a pivotal role in aged care, yet little is known about their capacity to provide palliative care in nursing homes. This study aimed to investigate GPs' perceptions and understanding of a palliative approach. A convenience sample of rural GPs (n = 13) participated in a series of three focus groups undertaken in August, 2005. These focus groups were all audio-taped, transcribed, and analyzed using thematic content analysis. Four key themes emerged: uncertainty about a palliative approach, a need to reorientate providers, the challenges of managing third parties, and making it work and moving forward. These preliminary findings suggest that integrating a palliative approach in aged care requires GPs to have a greater awareness of this paradigm and to be more effectively engaged in multidisciplinary care planning.

End-of-life care in rural general practice: how best to support commitment and meet challenges?

“…General Practitioners in this study did not consider financial benefits as a factor in care, despite expressing criticism over the current fee-for-service payment model. Our findings are in line with the growing calls for the development of Medicare items specifically for GP palliative care and for the simplification of claim processes [44] to ensure financially feasible and sustainable community-based systems [14,45]. Duckett has noted the lower incentives for community-based palliative care compared to hospital-based palliative care in Australia and recommends an activity-based bundled funding model which incorporates performance monitoring and reporting [46].…”

End-of-life expectations and experiences among nursing home patients and their relatives—A synthesis of qualitative studies

“…There are many reasons why the availability and competence of nursing home doctors so often are reported to be suboptimal, including the organizing and funding systems for nursing home doctors [41], the low status of nursing home medicine and perhaps also the discomfort many doctors feel in handling end-of-life questions [42]. Our analysis supports previous studies indicating specific challenges for nursing home doctors that deserve further attention in research and educational development [43][44][45].…”

Australian general practitioner attitudes to residential aged care facility visiting

“…Our findings support the evidence that some doctors do not feel adequately trained to deal with the complex care needs of these frail older patients (Gleeson, Jennings, Gavin, McConaghy, & Collins, ), and that there is a lot of uncertainty about their capacity to provide palliative care to RACF residents (Phillips et al., ). Palliative care education and support has been shown to facilitate better patient outcomes (Antunes, Harding, & Higginson, ).…”

“…Additionally, GPs find delivering palliative care and interacting with families in this setting difficult and feel educationally unprepared (Levy, Sing-I, & Kramer, 2007;Phillips, Davidson, & Willcock, 2009). Finally, in the local context, Australian GPs find the timeconsuming paperwork involved in RACF visiting unappealing (Gadzhanova & Reed, 2007), and they regard RACF work as poorly paid (Burgess, Davis, & Morgans, 2015).…”