Improving palliative care provision in primary care: a pre- and post-survey evaluation among PaTz groups

Plas, A.G.M. van der; Pasman, H. Roeline W.; Schweitzer, B.

doi:10.3399/bjgp18x695753

Cited by 12 publications

(27 citation statements)

References 16 publications

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“…The PaTz groups are teams consisting of GPs and community nurses, who, supervised by a physician with expert training in palliative care, discuss their palliative patients five to six times a year. 35 Furthermore, multidisciplinary team meetings were mentioned, such as interdisciplinary consultation and moral case deliberation. Ethical discussions or moral deliberation services are not easily available and accessible in primary care in the Netherlands, hence they may be unaware of these options.…”

Section: Resultsmentioning

confidence: 99%

Supporting GPs around euthanasia requests from people with dementia: a qualitative analysis of Dutch nominal group meetings

et al. 2020

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BackgroundEuthanasia has been regulated by law under strict conditions in the Netherlands since 2002. Since then the number of euthanasia cases has constantly increased, and increased exponentially for patients with dementia (PWD). The number of euthanasia requests by such patients is even higher. Recently, an interview study showed that physicians who are confronted with a PWD’s euthanasia request experience problems with communication, pressure from relatives, patients, and society, workload, interpretation of the law, and ethical considerations. Moreover, if honoured, the physician and patient may interpret the right moment for euthanasia differently.AimTo identify ways of supporting GPs confronted with a PWD’s euthanasia request.Design and settingTwo expert nominal group meetings were organised with Dutch care physicians for older people, GPs, legal experts, a healthcare chaplain, a palliative care consultant, and a psychologist.MethodA total of 15 experts participated in the meetings. Both meetings were audio-recorded, transcribed verbatim, and analysed using thematic analysis.ResultsFour themes emerged from the meetings: support provided by healthcare professionals, influencing public opinion, educational activities, and managing time and work pressure. The need for support was considered highest for GPs for all of these themes.ConclusionConsensus was reached with the help of experts on support needs for GPs confronted with euthanasia requests from PWD. A concise and clear explanation of the law is strongly desired. Changing public opinion seems the most challenging and a long-term aim. Communication training for finding the right balance between the physician’s professional responsibility and the patient’s autonomy should be made available, as a short-term aim.

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Section: Resultsmentioning

confidence: 99%

Supporting GPs around euthanasia requests from people with dementia: a qualitative analysis of Dutch nominal group meetings

et al. 2020

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“…PaTz-participants feel that PaTz improves collaboration, while strengthening participants' expertise and providing emotional support [15], and PaTz is associated with improved communication, both between healthcare providers and with patients [18]. The PaTz-register seems a crucial element in PaTzgroups, as compared to patients who are not on the register, the preferred place of death is more often known for patients who are on the register, who also are less often admitted to the hospital in the final month [19]. In addition, their death is anticipated earlier by their GP, treatment is aimed at palliation earlier and they more often have conversations on end of life topics, like life expectancy and palliative care treatment options [19].…”

Section: Introductionmentioning

confidence: 99%

“…The PaTz-register seems a crucial element in PaTzgroups, as compared to patients who are not on the register, the preferred place of death is more often known for patients who are on the register, who also are less often admitted to the hospital in the final month [19]. In addition, their death is anticipated earlier by their GP, treatment is aimed at palliation earlier and they more often have conversations on end of life topics, like life expectancy and palliative care treatment options [19].…”

Section: Introductionmentioning

confidence: 99%

Variation in the implementation of PaTz: a method to improve palliative care in general practice - a prospective observational study

et al. 2020

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Background: PaTz (palliative care at home) is a method to improve palliative care in the primary care setting in the Netherlands. PaTz has three basic principles: (1) local GPs and DNs meet at least six times per year to identify and discuss their patients with a life-threatening illness; (2) these meetings are supervised by a specialist palliative care professional; (3) groups use a palliative care register on which all identified patients are listed. Since the start in 2010, the number of PaTz-groups in the Netherlands has been growing consistently. Although the theory of all PaTz-groups is the same, the practical functioning of PaTz-groups may vary substantially, which may complicate further implementation of PaTz as well as interpretation of effect studies. This study aims to describe the variation in practice of PaTz-groups in the Netherlands.Method: In this prospective observational study, ten PaTz-groups logged and described the activities in their meetings as well as the registered and discussed patients and topics of discussions in registration forms for a 1 year follow-up period. In addition, non-participatory observations were performed in all participating groups. Meeting and patient characteristics were analysed using descriptive statistics. Conventional content analysis was performed in the analysis of topic discussions. Results: While the basic principles of PaTz are found in almost every PaTz-group, there is considerable variation in the practice and content of the meetings of different PaTz-groups. Most groups spend little time on other topics than their patients, although the number of patients discussed in a single meeting varies considerably, as well as the time spent on an individual patient. Most registered patients were diagnosed with cancer and patient discussions mainly concerned current affairs and rarely concerned future issues. Conclusion:The basic principles are the cornerstone of any PaTz-group. At the same time, the observed variation between PaTz-groups indicates that tailoring a PaTz-group to the needs of its participants is important and may enhance its sustainability. The flexibility of PaTz-groups may also provide opportunity to modify the content and tools used, and improve identification of palliative patients and advance care planning.

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“…In palliative care, patients’ desire for information has been shown to contrast with a failure by physicians to predict prognosis. 12 , 14 , 15 Studies have also shown that even if they are able to predict poor prognosis, GPs and HPs are reluctant to discuss poor prognosis and preferences regarding related treatment and care with patients and their relatives. 16 – 21 Other studies have identified deficits in information exchange and communication between physicians, including those working in different care settings.…”

Section: Introductionmentioning

confidence: 99%

Physicians’ perspectives on estimating and communicating prognosis in palliative care: a cross-sectional survey

et al. 2020

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BackgroundAdvance care planning (ACP) can help to enhance the care of patients with limited life expectancy. Despite physicians’ key role in ACP, the ways in which physicians estimate and communicate prognosis can be improved.AimTo determine how physicians in different care settings self-assess their performance in estimating and communicating prognosis to patients in palliative care, and how they perceive their communication with other physicians about patients’ poor prognosis.Design & settingA survey study was performed among a random sample of GPs, hospital physicians (HPs), and nursing home physicians (NHPs) in the southwest of the Netherlands (n = 2212).MethodA questionnaire was developed that had three versions for GPs, HPs, and NHPs. Each specialism filled in an appropriate version.ResultsA total of 547 physicians participated: 259 GPs, 205 HPs, and 83 NHPs. In the study, 61.1% of physicians indicated being able to adequately estimate whether a patient will die within 1 year, which was associated with use of the Surprise Question (odds ratio [OR] = 1.65, P = 0.042). In the case of a prognosis of <1 year, 75.0% of physicians indicated that they communicate with patients about preferences regarding treatment and care, which was associated with physicians being trained in palliative care (OR = 2.02, P=0.007). In cases where patients with poor prognosis are discharged after hospital admission, 83.4% of HPs indicated that they inform GPs about these patients’ preferences compared with 29.0% of GPs, and 21.7% of NHPs, who indicated that they are usually adequately informed about the preferences.ConclusionThe majority of physicians indicated that they believe they can adequately estimate patients’ limited life expectancy and that they discuss patients’ preferences for care. However, more physicians should be trained in communicating about patients’ poor prognosis and care preferences.

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Improving palliative care provision in primary care: a pre- and post-survey evaluation among PaTz groups

Abstract: Implementation of PaTz improved systematic identification of palliative care patients within the GP practice. Use of the PaTz register has added value.

Cited by 12 publications

References 16 publications

Supporting GPs around euthanasia requests from people with dementia: a qualitative analysis of Dutch nominal group meetings

Supporting GPs around euthanasia requests from people with dementia: a qualitative analysis of Dutch nominal group meetings

Variation in the implementation of PaTz: a method to improve palliative care in general practice - a prospective observational study

Physicians’ perspectives on estimating and communicating prognosis in palliative care: a cross-sectional survey

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