GP and nurses' perceptions of how after hours care for people receiving palliative care at home could be improved: a mixed methods study

Abstract

Background: Primary health care providers play a dominant role in the provision of palliative care (PC) in Australia but many gaps in after hours service remain. In some rural areas only 19% of people receiving palliative care achieve their goal of dying at home. This study, which builds on an earlier qualitative phase of the project, investigates the gaps in care from the perspective of general practitioners (GPs) and PC nurses.

Cuidados paliativos e a atenção primária à saúde: scoping review

“…Communication also fails between doctors and nurses, among members of the Primary Health care team 18,19 and teams of different services 12,16,20. Primary Health Care doctors complain that the specialists do not share information 20 . In cases of cardiorespiratory diseases, Primary Health Care physicians feel frustrated for failing to take full care of the patients as, during the worsening crisis of underlying diseases, the specialists of the hospital are the ones who manage the palliative care.…”

“…Insecurity, lack of access to emergency drugs, the lack of interpreters to attend the aboriginal population, the high cost of overtime and the limited cell phone coverage are aspects that justify the non-availability of these professionals to work at night. They claim that an amendment of the legislation in order to allow nurses to make the assessment of death could increase the participation of these professionals in the palliative care, especially in shifts after opening hours of the primary health care 18 . Doctors of primary health care, in turn, also mention some obstacles to their involvement with palliative care: lack of time; home visits; personal or family commitments; lack of interest; unavailability for work after hours; lack of knowledge of palliative care; emotional reasons, and lack of support of specialists 20 .…”

“…The nurses agree that the limited availability of doctors to work after hours is one of the limiting factors for palliative care in the primary health care system. In turn, doctors claim that the unavailability of nurses for work after hours is also a limiting factor 18 . Doctors and nurses have proposed some strategies for improvement of work in home-based palliative care: regular multidisciplinary meetings; easiness of referral to specialised services of palliative care; more nurses for home visits; nursing training in telephone service after the opening hours of the primary health care and, especially, the development and adoption of standardised protocols for the plan of treatment concerning each patient 18 .…”

“…In turn, doctors claim that the unavailability of nurses for work after hours is also a limiting factor 18 . Doctors and nurses have proposed some strategies for improvement of work in home-based palliative care: regular multidisciplinary meetings; easiness of referral to specialised services of palliative care; more nurses for home visits; nursing training in telephone service after the opening hours of the primary health care and, especially, the development and adoption of standardised protocols for the plan of treatment concerning each patient 18 . Professionals in the primary health care involved in palliative care wish to continue in the program, but the scarcity of resources, lack of organisation and management of services cause overload 10,16 .…”

O processo de cuidar de famílias de idosos em situação de final de vida na estratégia saúde da família

“…Ternestedt, 2009, Hewison et al, 2009, Radwany, Clough, Mason, 2009, Lallemand et al, 2010, Stajduhar et al, 2011, inclusive quando a família vivencia a fase de final de vida no domicílio (Graaff, Francke, 2009, Tan et al, 2009, Peterson et al, 2010 e, especificamente, quando a morte do idoso ocorre nesse cenário (Hirano et al, 2011 (Castro, Vargas, 2005).…”