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

Abstract

ObjectivesTo explore general practitioners' (GPs) current involvement in and attitudes towards the provision of palliative care in primary care. MethodsPostal survey of 356 London-based GPs assessing attitudes towards palliative care provision, district nursing and specialist palliative care services, and priorities for future service development. Results 65%of GPs were currently providing palliative care to patients on their list; 72% agreed or strongly agreed palliative care was a central part of their role. 27% wanted to hand care over to specialists. Most GPs (66%) disagreed with the statement that "palliative care is mainly district nursing (DN) work". Many were unaware of out of hours DN and specialist palliative care services. Multivariable analysis found four GP characteristics (larger practice size, more years experience as a GP, receipt of palliative care education, and current provision of 4 palliative care) were associated with agreement that palliative care was central to a GPs' role. ConclusionA minority of NHS GPs in London would rather have no involvement in palliative care in primary care. Knowledge of current services for palliative care is generally poor among GPs. These findings highlight potential gaps in services, particularly in small practices. Specialists will need to consider these factors in working with GPs to develop primary palliative care and to enable greater access to specialist palliative care.

The expanding role of primary care in cancer control

“…204 Despite the substantial input needed from primary care to accommodate such wishes, this transition could be made from one specialist team to another, with little thought of engaging the PCP in a meaningful way. 205 Although ideally all PCPs would be involved in palliative care, their involvement in highincome countries ranges from around 85% 206,207 in the UK and Australia to less than 50% in Japan. 208 Diff erences might also exist in PCP involvement between urban and rural settings.…”

“…Logistical issues related to time and travelling to provide home visits are cited by PCPs as prominent barriers, 206 particularly outside regular offi ce hours. Provision of palliative care is time intensive because of the complexity of symptom management, the psychosocial issues that arise or are intensifi ed at the end of life, the necessity of communicating sensitively with both patients and their families, and the fact that care is often delivered in the home setting.…”

“…In a survey of GPs in the UK, agreement that palliative care was a central part of their role increased with the number of physicians in the group, from 47% for solo physicians to 85% for groups with more than eight physicians. 206 In countries such as the Netherlands, Denmark, and the UK, the establishment of out-of-hours cooperatives has changed the manner in which care is provided.…”

Non-cancer palliative care in the community needs greater interprofessional collaboration to maintain coordinated care and manage uncertainty

“…Studies show that PC professionals are providing palliative care to patients and consider this an important or even central part of their role 1 2. However, patients with non-cancer conditions often experience community palliative care as inadequate and in need of planning and innovation 3.…”

Regional Medical Professionals' Confidence in Providing Palliative Care, Associated Difficulties and Availability of Specialized Palliative Care Services in Japan

“…Potentially effective strategies for developing regional palliative care programs should include basic education of medical professionals. Because general practitioners (GPs) and home visiting nurses (HVNs) have key roles in the community (4,5), educational programs targeting these medical professionals are particularly necessary.…”