General practice physicians' and nurses' self-reported multidisciplinary end-of-life care

A systematic review

Hugh Senior, Matthew Grant, Joel J. Rhee, Michèle Aubin, Peta McVey, Claire Johnson, Leanne Monterosso, Harriet Nwachukwu, Julia Fallon-Ferguson, Patsy Yates, Briony Williams, Geoffrey Mitchell

Research output: Contribution to journalReview ArticleResearchpeer-review

Abstract

Background: General practitioners (GPs) and general practice nurses (GPNs) face increasing demands to provide end-of-life care (EoLC) as the population ages. To enhance primary palliative care (PC), the care they provide needs to be understood to inform best practice models of care. Objective: To provide a comprehensive description of the self-reported role and performance of GPs and GPNs in (1) specific medical/nursing roles, (2) communication, (3) care co-ordination, (4) access and out-of-hours care, and (5) multidisciplinary care. Method: Systematic literature review. Data included papers (2000 to 2017) sought from Medline, Psychinfo, Embase, Joanna Briggs Institute and Cochrane databases. Results: From 6209 journal articles, 29 reviewed papers reported the GPs' and GPNs' role in EoLC or PC practice. GPs report a central role in symptom management, treatment withdrawal, non-malignant disease management and terminal sedation. Information provision included breaking bad news, prognosis and place of death. Psychosocial concerns were often addressed. Quality of communication depended on GP-patient relationships and GP skills. Challenges were unrealistic patient and family expectations, family conflict and lack of advance care planning. GPs often delayed end-of-life discussions until 3 months before death. Home visits were common, but less so for urban, female and part-Time GPs. GPs co-ordinated care with secondary care, but in some cases parallel care occurred. Trust in, and availability of, the GP was critical for shared care. There was minimal reference to GPNs' roles. Conclusions: GPs play a critical role in palliative care. More work is required on the role of GPNs, case finding and models to promote shared care, home visits and out-of-hours services.

Original languageEnglish
Number of pages11
JournalBMJ Supportive and Palliative Care
DOIs
Publication statusAccepted/In press - 29 Aug 2019

Keywords

  • case management
  • general practice
  • palliative care
  • patient care team
  • primary health care
  • systematic review

Cite this

Senior, Hugh ; Grant, Matthew ; Rhee, Joel J. ; Aubin, Michèle ; McVey, Peta ; Johnson, Claire ; Monterosso, Leanne ; Nwachukwu, Harriet ; Fallon-Ferguson, Julia ; Yates, Patsy ; Williams, Briony ; Mitchell, Geoffrey. / General practice physicians' and nurses' self-reported multidisciplinary end-of-life care : A systematic review. In: BMJ Supportive and Palliative Care. 2019.
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General practice physicians' and nurses' self-reported multidisciplinary end-of-life care : A systematic review. / Senior, Hugh; Grant, Matthew; Rhee, Joel J.; Aubin, Michèle; McVey, Peta; Johnson, Claire; Monterosso, Leanne; Nwachukwu, Harriet; Fallon-Ferguson, Julia; Yates, Patsy; Williams, Briony; Mitchell, Geoffrey.

In: BMJ Supportive and Palliative Care, 29.08.2019.

Research output: Contribution to journalReview ArticleResearchpeer-review

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T1 - General practice physicians' and nurses' self-reported multidisciplinary end-of-life care

T2 - A systematic review

AU - Senior, Hugh

AU - Grant, Matthew

AU - Rhee, Joel J.

AU - Aubin, Michèle

AU - McVey, Peta

AU - Johnson, Claire

AU - Monterosso, Leanne

AU - Nwachukwu, Harriet

AU - Fallon-Ferguson, Julia

AU - Yates, Patsy

AU - Williams, Briony

AU - Mitchell, Geoffrey

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N2 - Background: General practitioners (GPs) and general practice nurses (GPNs) face increasing demands to provide end-of-life care (EoLC) as the population ages. To enhance primary palliative care (PC), the care they provide needs to be understood to inform best practice models of care. Objective: To provide a comprehensive description of the self-reported role and performance of GPs and GPNs in (1) specific medical/nursing roles, (2) communication, (3) care co-ordination, (4) access and out-of-hours care, and (5) multidisciplinary care. Method: Systematic literature review. Data included papers (2000 to 2017) sought from Medline, Psychinfo, Embase, Joanna Briggs Institute and Cochrane databases. Results: From 6209 journal articles, 29 reviewed papers reported the GPs' and GPNs' role in EoLC or PC practice. GPs report a central role in symptom management, treatment withdrawal, non-malignant disease management and terminal sedation. Information provision included breaking bad news, prognosis and place of death. Psychosocial concerns were often addressed. Quality of communication depended on GP-patient relationships and GP skills. Challenges were unrealistic patient and family expectations, family conflict and lack of advance care planning. GPs often delayed end-of-life discussions until 3 months before death. Home visits were common, but less so for urban, female and part-Time GPs. GPs co-ordinated care with secondary care, but in some cases parallel care occurred. Trust in, and availability of, the GP was critical for shared care. There was minimal reference to GPNs' roles. Conclusions: GPs play a critical role in palliative care. More work is required on the role of GPNs, case finding and models to promote shared care, home visits and out-of-hours services.

AB - Background: General practitioners (GPs) and general practice nurses (GPNs) face increasing demands to provide end-of-life care (EoLC) as the population ages. To enhance primary palliative care (PC), the care they provide needs to be understood to inform best practice models of care. Objective: To provide a comprehensive description of the self-reported role and performance of GPs and GPNs in (1) specific medical/nursing roles, (2) communication, (3) care co-ordination, (4) access and out-of-hours care, and (5) multidisciplinary care. Method: Systematic literature review. Data included papers (2000 to 2017) sought from Medline, Psychinfo, Embase, Joanna Briggs Institute and Cochrane databases. Results: From 6209 journal articles, 29 reviewed papers reported the GPs' and GPNs' role in EoLC or PC practice. GPs report a central role in symptom management, treatment withdrawal, non-malignant disease management and terminal sedation. Information provision included breaking bad news, prognosis and place of death. Psychosocial concerns were often addressed. Quality of communication depended on GP-patient relationships and GP skills. Challenges were unrealistic patient and family expectations, family conflict and lack of advance care planning. GPs often delayed end-of-life discussions until 3 months before death. Home visits were common, but less so for urban, female and part-Time GPs. GPs co-ordinated care with secondary care, but in some cases parallel care occurred. Trust in, and availability of, the GP was critical for shared care. There was minimal reference to GPNs' roles. Conclusions: GPs play a critical role in palliative care. More work is required on the role of GPNs, case finding and models to promote shared care, home visits and out-of-hours services.

KW - case management

KW - general practice

KW - palliative care

KW - patient care team

KW - primary health care

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