Systematic review of the effectiveness, barriers and facilitators to general practitioner engagement with specialist secondary services in integrated palliative care

Carmont, Sue-Ann; Mitchell, Geoffrey; Senior, Hugh; Foster, Michele

doi:10.1136/bmjspcare-2016-001125

Cited by 46 publications

(68 citation statements)

References 23 publications

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“…9 Exploring GPs' views on best practice palliative care can inform healthcare delivery Several studies have sought GPs' perceptions of barriers and enablers to the delivery of best practice palliative care. [10][11][12][13][14] There have also been a number of policy papers highlighting the important features of delivering best practice palliative care. 5,15 However, most GPs are still self-defining their role in palliative care delivery.…”

Section: Introductionmentioning

confidence: 99%

General practitioners’ perceptions of best practice care at the end of life: a qualitative study

et al. 2019

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BackgroundGPs can play a central role in palliative care delivery. However, little is known about their views on what constitutes best practice care at the end of life.AimTo explore, in a sample of Australian GPs, their perceptions of best practice palliative care and their ideal role in its delivery.Design & settingA qualitative interview study of 25 GPs practising in metropolitan and non-metropolitan locations in New South Wales, Australia.MethodSemi-structured telephone interviews were conducted. Data were analysed using qualitative content analysis.ResultsParticipants had a mean age of 51 years, and had practised between 3 and 38 years (mean 19 years). Best practice palliative care was perceived to be proactive and responsive to a wide range of patient and family needs. Many participants indicated a need for relational continuity, which involves GPs establishing a care pathway from diagnosis to palliation, coordinating care across the pathway, and collaborating with other healthcare providers. A number of participants perceived palliative care as a natural extension of primary care and indicated that best practice palliative care mainly requires experiential knowledge and good communication skills, rather than specialised medical knowledge. Participants listed a number of communication strategies to offer patients and their families choice and ongoing negotiation about the recommended treatments.ConclusionThis study provides novel in-depth insights into GPs’ perceptions of best practice palliative care. Future research should further investigate the identified features of care, and whether they can maximise the outcomes of patients and their families.

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Section: Introductionmentioning

confidence: 99%

General practitioners’ perceptions of best practice care at the end of life: a qualitative study

et al. 2019

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“…A systematic literature review 2 showed that in countries such as Australia, New Zealand, Canada and countries of Europe, where medical records of patients are shared by the health systems, the choice of actions and care measures in during emergency calls are facilitated. The study also emphasized that when the information is integrated between primary care and specialized PC services, positive factors are observed in terms of less repeated admissions and shortest hospital stay, besides relevant improvements in pain control and other symptoms and, consequently, improved QOL for patients.…”

Section: Discussionmentioning

confidence: 99%

“…What are the limitations and possibilities that you nd when providing this type of assistance in the emergency service? (2) In emergency services, professionals seek to save lives. Do you think you are prepared to 'deal' with the death of a terminally ill patient during a call in which the SAMU is requested to promote comfort and/or pain relief at that moment?…”

Section: Methodsmentioning

confidence: 99%

“…If I am not aware that the patient is in palliative care, the family does not know that he is in palliative care, from that moment on this is a patient with prognosis. So, if he is a patient with a prognosis, then he is a patient with whom I will act as in an emergency, I will intubate, I will resuscitate, I will take all these measures" (12) "For sure, for sure, and I bring again the issue of lack of information, so many times we make so many mistakes, the patient is many times in palliative care or not, and ends up going through invasive procedures, what it was maybe against the patient's or the family's desire, but we don't have this information, there is nothing written" (2) "And if we don't have this history, if we don't know or if we want to apply our protocol, which may go eventually against palliative care, it can certainly worsen or even in uence the diagnosis or the survival of this palliative patient" (10) Theme: Dysthanasia Despite treating the subject of death as a taboo, the health professionals responding the study recognized that the professional performance in PHC contributes to an approach based on futile therapies that sometimes prolong the suffering of patients and family members.…”

Section: Subtopic: Familymentioning

confidence: 99%

“…Palliative Care (PC) is de ned as an approach that improves the Quality of Life (QOL) of patients and their families who face issues associated with life-threatening chronic diseases, through the prevention and relief of suffering 1 . The offer of PC covers a wide variety of scenarios including hospitals, hospices, nursing homes and home care, and is classi ed into general or specialized care 2 .…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Palliative Care in the Pre-Hospital Service In Brazil: Experiences of Health Professionals

Boaventura

Pessalácia

Ribeiro

et al. 2020

Preprint

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Background: An integrated care network between emergency, specialized and primary care services can prevent repeated hospitalizations and the institutionalized death of terminally ill patients in palliative care (PC). To identify the perception of professionals in a pre-hospital care (PHC) service about the outcomes of the assistance provided to patients eligible for PC. Methods: Study with a qualitative approach, of interpretative nature, based on the perspective of Ricouer's Dialectical Hermeneutics. Results: Three central themes emerged out of the professionals' speeches: (1) unpreparedness of the team, (2) decision making, and (3) dysthanasia. Conclusions: It is necessary to invest in professional training associated with PC in the home context and its peculiarities, adopt a specific policy for PC that involves all levels of care, including PHC, and adopt a unified information system, as well as more effective procedures that favor the respect for the patients' will, without generating dissatisfaction to the team and the family.

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Barriers and facilitators systematic reviews in health: A methodological review and recommendations for reviewers

Bach-Mortensen

Verboom

2020

Research Synthesis Methods

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Background: Systematic reviews cataloguing the barriers to and facilitators of various outcomes are increasingly popular, despite criticisms of this type of review on philosophical, methodological, and practical grounds. The aims of this review are to appraise, analyze, and discuss the reporting and synthesis practices used in recently published barriers and facilitators reviews in health services research. Methods: All English-language peer-reviewed systematic reviews that synthesized research on barriers and facilitators in a health services context were eligible for inclusion. We searched 11 databases over a 13-month period (1 November 2017-30 November 2018) using an exhaustive list of search terms for "barrier(s)," "facilitator(s)," and "systematic review." Results: One hundred reviews were included. We found a high degree of variation in the synthesis practices used in these reviews, with the majority employing aggregative (rather than interpretive) approaches. The findings echo common critiques of this review type, including concerns about the reduction of complex phenomena to simplified, discrete factors. Although several reviews highlighted the "complexity" of barriers and facilitators, this was usually not analyzed systematically. Analysis of the subsample of reviews that explicitly discussed the barriers and facilitators approach revealed some common issues. These tended to be either conceptual/definitional (eg, ideas about interrelationships and overlap between factors) and methodological/practical (eg, challenges related to aggregating heterogeneous research). Conclusion: Barriers and facilitators reviews should (a) clearly operationally define "barrier" and "facilitator," (b) explicitly describe how factors are extracted and subsequently synthesized, and (c) provide critical reflection on the contextual variability and reliability of identified factors.

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Systematic review of the effectiveness, barriers and facilitators to general practitioner engagement with specialist secondary services in integrated palliative care

Abstract: This is an emerging field and further research is required assessing the effectiveness of different models of integrated palliative care.

Cited by 46 publications

References 23 publications

General practitioners’ perceptions of best practice care at the end of life: a qualitative study

General practitioners’ perceptions of best practice care at the end of life: a qualitative study

Palliative Care in the Pre-Hospital Service In Brazil: Experiences of Health Professionals

Barriers and facilitators systematic reviews in health: A methodological review and recommendations for reviewers

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