Review: Improving end-of-life care: a critical review of the Gold Standards Framework in primary care

Shaw, Karen L.; Clifford, Colette; Kirste, Thomas; Meehan, Helen

doi:10.1177/0269216310362005

Cited by 155 publications

(131 citation statements)

References 14 publications

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“…Older people living at home may also have more need for a transfer to a different care setting or to hospital because organising home care 24 hours per day can be difficult, especially at short notice. Initiatives aimed at improving the provision of palliative care in home settings specifically, 25 or in addition to other settings, 26,27 …”

Section: Comparison With Existing Literaturementioning

confidence: 99%

Comparison of end-of-life care for older people living at home and in residential homes: a mortality follow-back study among GPs in the Netherlands

et al. 2015

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BackgroundThe proportion of older people is increasing, therefore their place of residence and place of care at the end of life are becoming increasingly important. AimTo compare aspects of end-of-life care among older people in residential homes and home settings in the Netherlands. Design and settingNationwide representative mortality followback study among GPs in the Netherlands. MethodThe study included patients aged ≥65 years who died non-suddenly, whose longest place of residence in their last year of life was at home or in a residential home (n = 498). Differences were analysed using Pearson's χ 2 test, MannWhitney U tests, and multivariate logistic regression. ResultsControlling for the differences between the populations in home settings and residential homes, no differences were found in treatment goals, communication about end-of-life care, or use of specialised palliative care between the two settings. However, people living in a residential home were more likely to have received palliative care from a GP than people living at home (OR 2.84, 95% confidence interval [CI] = 1.41 to 5.07). In residential homes, people more often experienced no transfer between care settings (OR 2.76, 95% CI = 1.35 to 5.63) and no hospitalisations (OR 2.2, 95% CI = 1.04 to 4.67) in the last 3 months of life, and died in hospital less often (OR 0.78, 95% CI = 0.63 to 0.97) than those people living at home. ConclusionDespite similar treatment goals, care in residential homes seems more successful in avoiding transfers and hospitalisation at the end of life. Especially since older people are encouraged to stay at home longer, measures should be taken to ensure they are not at higher risk of transfers and hospitalisations in this setting. Keywordsend of life care; general practitioner; palliative care; residential facilities; terminal care.

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Section: Comparison With Existing Literaturementioning

confidence: 99%

Comparison of end-of-life care for older people living at home and in residential homes: a mortality follow-back study among GPs in the Netherlands

et al. 2015

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“…Greater attention to communication and work across settings is found in the Gold Standards Framework (GSF) for patients in the last months of life. 58 This aims to support generalist professionals to work together to provide high-quality care regardless of the setting. The GSF proposes a three-stage approach to care: identify, assess and plan.…”

Section: Care Pathwaysmentioning

confidence: 99%

Transitions at the end of life for older adults – patient, carer and professional perspectives: a mixed-methods study

Hanratty

Lowson

Grande

et al. 2014

Health Services and Delivery Research

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BackgroundThe end of life may be a time of high service utilisation for older adults. Transitions between care settings occur frequently, but may produce little improvement in symptom control or quality of life for patients. Ensuring that patients experience co-ordinated care, and moves occur because of individual needs rather than system imperatives, is crucial to patients’ well-being and to containing health-care costs.ObjectiveThe aim of this study was to understand the experiences, influences and consequences of transitions between settings for older adults at the end of life. Three conditions were the focus of study, chosen to represent differing disease trajectories.SettingEngland.ParticipantsThirty patients aged over 75 years, in their last year of life, diagnosed with heart failure, lung cancer and stroke; 118 caregivers of decedents aged 66–98 years, who had died with heart failure, lung cancer, stroke, chronic obstructive pulmonary disease or selected other cancers; and 43 providers and commissioners of services in primary care, hospital, hospice, social care and ambulance services.Design and methodsThis was a mixed-methods study, composed of four parts: (1) in-depth interviews with older adults; (2) qualitative interviews and structured questionnaire with bereaved carers of older adult decedents; (3) telephone interviews with care commissioners and providers using case scenarios derived from the interviews with carers; and (4) analysis of linked Hospital Episode Statistics (HES) and mortality data relating to hospital admissions for heart failure and lung cancer in England 2001–10.ResultsTransitions between care settings in the last year of life were a common component of end-of-life care across all the data sets that made up this study, and many moves were made shortly before death. Patients’ and carers’ experiences of transitions were of a disjointed system in which organisational processes were prioritised over individual needs. In many cases, the family carer was the co-ordinator and provider of care at home, excluded from participation in institutional care but lacking the information and support to extend their role with confidence. The general practitioner (GP) was a valued, central figure in end-of-life care across settings, though other disciplines were critical of GPs’ expertise and adherence to guidelines. Out-of-hours services and care homes were identified by many as contributors to unnecessary transitions. Good relationships and communication between professionals in different settings and sectors was recognised by families as one of the most important influences on transitions but this was rarely acknowledged by staff.ConclusionsDevelopment of a shared understanding of professional and carer roles in end-of-life transitions may be one of the most effective ways of improving patients’ experiences. Patients and carers manage many aspects of end-of-life care for themselves. Identifying ways to extend their skills and strengthen their voices, particularly in hospital settings, would be welcomed and may reduce unnecessary end-of-life transitions. Why the experiences of carers appear to have changed little, despite the implementation of a range of relevant policies, is an important question that has not been answered. Recommendations for future research include the relationship between policy interventions and the experiences of end-of-life carers; identification of ways to harmonise understanding of the carers’ role and strengthen their voice, particularly in hospital settings; identification of ways to reduce the influence of interprofessional tensions in end-of-life care; and development of interventions to enhance patients’ experiences across transitions.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…34 In the UK, the GSF has been adopted by many GPs and seems to have value in daily practice to improve end-oflife care. 53 The GSF-PIG was developed by consulting different professional representatives, while RADPAC used a three-step procedure. Yet both approaches have resulted in very similar indicators, which strengthens their validity.…”

Section: Competing Interestsmentioning

confidence: 99%

Early identification of palliative care patients in general practice: development of RADboud indicators for PAlliative Care Needs (RADPAC)

Thoonsen

Engels²,

Rijswijk³

et al. 2012

Br J Gen Pract

109

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Review: Improving end-of-life care: a critical review of the Gold Standards Framework in primary care

Cited by 155 publications

References 14 publications

Comparison of end-of-life care for older people living at home and in residential homes: a mortality follow-back study among GPs in the Netherlands

Comparison of end-of-life care for older people living at home and in residential homes: a mortality follow-back study among GPs in the Netherlands

Transitions at the end of life for older adults – patient, carer and professional perspectives: a mixed-methods study

Early identification of palliative care patients in general practice: development of RADboud indicators for PAlliative Care Needs (RADPAC)

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