Systematic review of barriers and enablers to the delivery of palliative care by primary care practitioners

Abstract

Background: There is increasing demand for primary care practitioners to play a key role in palliative care delivery. Given this, it is important to understand their perceptions of the barriers and enablers to optimal palliative care, and how commonly these are experienced. Aim: To explore the type and prevalence of barriers and enablers to palliative care provision reported by primary care practitioners. Design: A systematic review of quantitative data-based articles was conducted. Data sources: Medline, Embase and PsychINFO databases were searched for articles published between January 2007 and March 2019. Data synthesis: Abstracts were assessed against the eligibility criteria by one reviewer and a random sample of 80 articles were blind coded by a second author. Data were extracted from eligible full-texts by one author and checked by a second. Given the heterogeneity in the included studies’ methods and outcomes, a narrative synthesis was undertaken. Results: Twenty-one studies met the inclusion criteria. The most common barriers related to bureaucratic procedures, communication between healthcare professionals, primary care practitioners’ personal commitments, and their skills or confidence. The most common enablers related to education, nurses and trained respite staff to assist with care delivery, better communication between professionals, and templates to facilitate referral to out-of-hours services. Conclusion: A holistic approach addressing the range of barriers reported in this review is needed to support primary care providers to deliver palliative care. This includes better training and addressing barriers related to the interface between healthcare services.

Palliative Care in a Death-Denying Culture: Exploring Barriers to Timely Palliative Efforts for Heart Failure Patients in the Primary Care Setting

“…15 Primary care providers find it difficult to support their patients and appropriately initiate palliative efforts without sufficient information from secondary care and hospitals, especially when their AHF patients depend so significantly on the guidance of a cardiologist. 21 The Miseducation of PC One of the most significant barriers to palliative referrals for AHF patients is the misperception that PC is a service reserved for those patients near death. 5 While some providers use increased symptom burden, functional decline, and events such as device implantation or heart transplant as triggers to make PC referrals for their AHF patients, Kavalieratos and colleagues show that it is frequently the practice of providers to use the "'point at which you are unable to do more'" as the driving trigger for PC referral.…”

Effectiveness and cost-effectiveness of out-of-hours palliative care: a systematic review

“…Finally, it is important to note that our findings do not mean that no literature on out-of-hours palliative care exists, simply that evaluations specifically were not identified. Our review identified, but did not include as eligible, topics including general practitioner perspectives on out-of-hours palliative care 48,49 ; pilot programmes on, inter alia, prescribing and telehealth 50,51 ; and an ongoing systematic review to identify quality improvement projects in out-of-hours palliative care 52 . These studies and others advance understanding outside of our evaluative focus, as well as potentially improving future evaluative studies.…”

Lack of education and co-ordination of care are main factors affecting palliative care provision by primary care practitioners

“…The purpose of this review2 was to explore the types and frequency of barriers and enablers to palliative care provision, as reported by practitioners. The authors conducted a systematic review of observational studies following the Joanna Briggs Institute (JBI)3 manual.…”