Specialist community palliative care services – a survey of general practitioners' experience in Eastern Sydney

Abstract

The role of the general practitioner (GP) in providing palliative care in the community is of increasing importance. Concomitantly, there is more interaction between the palliative care support services and the GP. Even when there is input from the palliative care support services, there can be barriers that impede effective delivery of palliative care by the GP. These include poor communication between the GP and the supporting team, inaccessibility of the service and inadequate after-hours coverage. We carried out a postal survey to assess what experiences and perceptions GPs working within the Eastern Sydney Area had of our palliative care support service. The response was generally favourable, with most GPs finding the level of communication, accessibility, usefulness of advice given and degree of follow-up visits by the service to be adequate. However, an important number felt that we tended to over-hospitalise our patients.

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.…”

“…33 Opportunities for education Education and training were identified as important facilitators of collaborative working, with the many of studies identifying education for generalists as a particular priority. 19,23,[24][25][26]28 Examples of successful education models for generalists included study days for care home staff, 22 practicebased education and decision support for GPs, 25 and educational inductions for palliative care partnership models involving GPs and practice nurses. 26 One study reported shared learning practices involving both specialists and generalists: as part of resource; working with specialist palliative care as an extended team; and handing over responsibility to the specialist palliative care team.…”

“…Generalists identified good out-of-hours care and access to round-the-clock support from specialist palliative care services as being key aspects of successful partnership working. 22,24,25,28 Specialist palliative care telephone consultation services for generalists were viewed positively in a number of studies exploring models of palliative care collaboration in the community. 18,22,28 Difficulty accessing specialist palliative care services was identified as a factor preventing GPs from becoming more involved in palliative care.…”