Evaluation of a scheme to enhance palliative cancer care in rural Wales

Abstract

Since the early 1990s, the United Kingdom has seen several initiatives designed to improve the quality of cancer palliative care in the community. We report on the evaluation of a project that took place in the rural county of Powys in Wales in which a group of general practitioner clinical facilitators (GPCFs) sought to raise the overall standard of palliative care among primary health care teams (PHCTs). The evaluation was conducted over 3 years and made use of several methods: interviews with facilitators and other key stakeholders at regular intervals throughout the project; a survey of PHCT members at two time points; an analysis of patterns of opioid prescribing in the county before and during the project; monitoring of referrals to specialist palliative care services out of county; and an analysis of place of death of those dying from cancer. The evaluation found that local general practitioners (GPs) were willing to work as facilitators and that they made contact with over two thirds of those in the PHCTs. Facilitators undertook a variety of clinical, educational and service development initiatives but did report on problems of role definition and time management. There were no marked changes in patterns of referral to specialist palliative care or in place of death, but there was some evidence to suggest that the facilitators had an influence on their colleagues' opioid prescribing patterns.

Systematic review of educational interventions in palliative care for primary care physicians

“…One intervention showed that the reference patterns to specialists made by the GP did not change, although the mean number of patients visited by specialists decreased significantly after the intervention. 25 In another study, the utility perception of PC services was significant. 41 Knowledge, attitude, satisfaction of physicians.…”

“…Outcomes registered (a) Related to the professional: objective measures of symptom control. The analysis of opioid prescription in two interventions showed a partial improvement in the increased use of morphine in one study, 25 and decreased use of fentanyl patches in both studies. 25,30 However, prescription of morphine solution was unchanged in one intervention, 30 a clear discrepancy to the answers of the questionnaires previously administered in the study.…”

“…The analysis of opioid prescription in two interventions showed a partial improvement in the increased use of morphine in one study, 25 and decreased use of fentanyl patches in both studies. 25,30 However, prescription of morphine solution was unchanged in one intervention, 30 a clear discrepancy to the answers of the questionnaires previously administered in the study. 29 An audit of three interventions showed positive change in medication use post-teaching intervention, 35 with an achievement of standards between 89 and 100%, 39 and treatment, according to guidelines, in 90%.…”

“…d) Prescription of opioids was analysed in two interventions. 25,30 e) Self-administered questionnaires were used to assess carer satisfaction in three interventions, 24,31,25 Á 28 but in only one was validation data of the questionnaire provided. 24 One study assessed patient satisfaction with a validated questionnaire.…”

General Practitioners' Attitudes to Palliative Care: A Western Australian Rural Perspective

“…These findings are reflected in the international arena. 10 A study conducted in Spain by Porta et al 11 explored urban, suburban, and rural GPs' assessments of support provided to the families of patients with terminal cancer. It was found that, the more rural the environment in which GPs worked, the more likely they were to acknowledge the need for providing ongoing support for patients and families.…”