How and why do GPs use specialist palliative care services?

Abstract

This study presents findings on the interaction of generalists and specialists within palliative care. General practitioners (GPs) are central to community palliative care as most of the last year of a patient's life is spent at home under the care of the primary health care team. GPs see few palliative care patients each year, however, and access to specialist palliative care services for support, advice and referral can be important particularly to support patients who wish to die at home. The aim of this study was to explore GP use of and attitudes towards specialist palliative care services through semi-structured interviews in inner city, urban and rural areas. It was part of a longitudinal evaluation of an educational intervention, and the quantitative components are reported elsewhere. Sixty-three GPs were interviewed, having been sampled randomly from inner city, urban and rural health authority district lists. While most interviewees reported using specialist palliative care services as a resource, other models of use included working together as an extended team, seldom using such services and handing over care or responsibility entirely. Availability of services clearly shaped use, but previous experience and expectations of easy access were also important. Patterns of use were not necessarily fixed, but dependent also on the differing needs of and wishes of patients and carers. Specialist palliative care services need to be aware of such variations in ways of working and to consider the implications for the capacity and flexibility of both primary care and specialist service provision.

Factors supporting good partnership working between generalist and specialist palliative care services: a systematic review

“…Eleven papers were concerned with exploring factors involved in, or attitudes to, partnership working. 5,15,17,20,21,24,28,31,[33][34][35] six were descriptions of the development or implementation of partnership working models. 16,18,19,22,25,30 and five were evaluations of partnership working models.…”

“…16,18,19,22,25,30 and five were evaluations of partnership working models. 23,26,27,29,32 Eleven of the papers used qualitative methods; 5,15,17,20,21,24,28,30,31,33,34 seven used quantitative methods; 19,22,23,25,27,29,35 three used mixed methods; 18,26,32 and one used a casestudy approach. 16 Some methodological weaknesses exist in the studies reviewed, so some caution must be exercised when attempting to draw any firm conclusions.…”

“…27 Poor communication was cited as a factor that prevented generalist staff from becoming more involved in palliative care. 24,31 Encouraging dialogue between specialities was identified as an important future priority. 21 Identified barriers to effective communication included a lack of processes for communication, 35 and issues establishing networks.…”

Roles, service knowledge and priorities in the provision of palliative care: a postal survey of London GPs

“…Some GPs use specialist palliative care services only infrequently, whilst others use them as a resource final group of GPs look to hand over care or responsibility completely to specialist services. 11 These widely varying approaches have important implications for specialist providers who offer advice and support to GPs within their local area.…”

How General Practitioners in Bulgaria Tackle Palliative Care?: A Cross-Sectional Study

“…Much like the situation in other countries, due to the fact that towns are satiated by various medical specialists, GPs in towns found it easier to care for their patients, to a degree of even giving over all medical activities to other services. 10 There was an adjustment in the most of GPs to coordinate palliative care in home setting, if it can be organized appropriately, which shows that the physicians look upon palliative care as their duty. With the passage of years, the GPs accumulate knowledge about the patient and his/her family, which helps to provide them with optimum care.…”