Systematic review of general practice end-of-life symptom control

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

Research output: Contribution to journalReview ArticleResearchpeer-review

7 Citations (Scopus)

Abstract

Background End of life care (EoLC) is a fundamental role of general practice, which will become more important as the population ages. It is essential that general practice’s role and performance of at the end of life is understood in order to maximise the skills of the entire workforce.

Objective To provide a comprehensive description of the role and performance of general practitioners (GPs) and general practice nurses (GPNs) in EoLC symptom control.

Method Systematic literature review of papers from 2000 to 2017 were sought from Medline, PsycINFO, Embase, Joanna Briggs Institute and Cochrane databases.

Results From 6209 journal articles, 46 papers reported GP performance in symptom management. There was no reference to the performance of GPNs in any paper identified. Most GPs expressed confidence in identifying EoLC symptoms. However, they reported lack of confidence in providing EoLC at the beginning of their careers, and improvements with time in practice. They perceived emotional support as being the most important aspect of EoLC that they provide, but there were barriers to its provision. GPs felt most comfortable treating pain, and least confident with dyspnoea and depression. Observed pain management was sometimes not optimal. More formal training, particularly in the use of opioids was considered important to improve management of both pain and dyspnoea.

Conclusions It is essential that GPs receive regular education and training, and exposure to EoLC from an early stage in their careers to ensure skill and confidence. Research into the role of GPNs in symptom control needs to occur.
Original languageEnglish
Pages (from-to)411-420
Number of pages10
JournalBMJ Supportive and Palliative Care
Volume8
Issue number4
DOIs
Publication statusPublished - Dec 2018

Cite this

Mitchell, G. K., Senior, H. E., Johnson, C. E., Fallon-Ferguson, J., Williams, B., Monterosso, L., ... Yates, P. M. (2018). Systematic review of general practice end-of-life symptom control. BMJ Supportive and Palliative Care, 8(4), 411-420. https://doi.org/10.1136/bmjspcare-2017-001374
Mitchell, Geoffrey K ; Senior, Hugh E ; Johnson, Claire E ; Fallon-Ferguson, Julia ; Williams, Briony ; Monterosso, Leanne ; Rhee, Joel J ; McVey, Peta ; Grant, Matthew P ; Aubin, Michèle ; Nwachukwu, Harriet TG ; Yates, Patsy M . / Systematic review of general practice end-of-life symptom control. In: BMJ Supportive and Palliative Care. 2018 ; Vol. 8, No. 4. pp. 411-420.
@article{e470f49316124f74b9007e81ded61588,
title = "Systematic review of general practice end-of-life symptom control",
abstract = "Background End of life care (EoLC) is a fundamental role of general practice, which will become more important as the population ages. It is essential that general practice’s role and performance of at the end of life is understood in order to maximise the skills of the entire workforce.Objective To provide a comprehensive description of the role and performance of general practitioners (GPs) and general practice nurses (GPNs) in EoLC symptom control.Method Systematic literature review of papers from 2000 to 2017 were sought from Medline, PsycINFO, Embase, Joanna Briggs Institute and Cochrane databases.Results From 6209 journal articles, 46 papers reported GP performance in symptom management. There was no reference to the performance of GPNs in any paper identified. Most GPs expressed confidence in identifying EoLC symptoms. However, they reported lack of confidence in providing EoLC at the beginning of their careers, and improvements with time in practice. They perceived emotional support as being the most important aspect of EoLC that they provide, but there were barriers to its provision. GPs felt most comfortable treating pain, and least confident with dyspnoea and depression. Observed pain management was sometimes not optimal. More formal training, particularly in the use of opioids was considered important to improve management of both pain and dyspnoea.Conclusions It is essential that GPs receive regular education and training, and exposure to EoLC from an early stage in their careers to ensure skill and confidence. Research into the role of GPNs in symptom control needs to occur.",
author = "Mitchell, {Geoffrey K} and Senior, {Hugh E} and Johnson, {Claire E} and Julia Fallon-Ferguson and Briony Williams and Leanne Monterosso and Rhee, {Joel J} and Peta McVey and Grant, {Matthew P} and Mich{\`e}le Aubin and Nwachukwu, {Harriet TG} and Yates, {Patsy M}",
year = "2018",
month = "12",
doi = "10.1136/bmjspcare-2017-001374",
language = "English",
volume = "8",
pages = "411--420",
journal = "BMJ Supportive and Palliative Care",
issn = "2045-435X",
publisher = "BMJ Publishing Group",
number = "4",

}

Mitchell, GK, Senior, HE, Johnson, CE, Fallon-Ferguson, J, Williams, B, Monterosso, L, Rhee, JJ, McVey, P, Grant, MP, Aubin, M, Nwachukwu, HTG & Yates, PM 2018, 'Systematic review of general practice end-of-life symptom control', BMJ Supportive and Palliative Care, vol. 8, no. 4, pp. 411-420. https://doi.org/10.1136/bmjspcare-2017-001374

Systematic review of general practice end-of-life symptom control. / Mitchell, Geoffrey K; Senior, Hugh E; Johnson, Claire E; Fallon-Ferguson, Julia; Williams, Briony ; Monterosso, Leanne; Rhee, Joel J; McVey, Peta ; Grant, Matthew P; Aubin, Michèle ; Nwachukwu, Harriet TG ; Yates, Patsy M .

In: BMJ Supportive and Palliative Care, Vol. 8, No. 4, 12.2018, p. 411-420.

Research output: Contribution to journalReview ArticleResearchpeer-review

TY - JOUR

T1 - Systematic review of general practice end-of-life symptom control

AU - Mitchell, Geoffrey K

AU - Senior, Hugh E

AU - Johnson, Claire E

AU - Fallon-Ferguson, Julia

AU - Williams, Briony

AU - Monterosso, Leanne

AU - Rhee, Joel J

AU - McVey, Peta

AU - Grant, Matthew P

AU - Aubin, Michèle

AU - Nwachukwu, Harriet TG

AU - Yates, Patsy M

PY - 2018/12

Y1 - 2018/12

N2 - Background End of life care (EoLC) is a fundamental role of general practice, which will become more important as the population ages. It is essential that general practice’s role and performance of at the end of life is understood in order to maximise the skills of the entire workforce.Objective To provide a comprehensive description of the role and performance of general practitioners (GPs) and general practice nurses (GPNs) in EoLC symptom control.Method Systematic literature review of papers from 2000 to 2017 were sought from Medline, PsycINFO, Embase, Joanna Briggs Institute and Cochrane databases.Results From 6209 journal articles, 46 papers reported GP performance in symptom management. There was no reference to the performance of GPNs in any paper identified. Most GPs expressed confidence in identifying EoLC symptoms. However, they reported lack of confidence in providing EoLC at the beginning of their careers, and improvements with time in practice. They perceived emotional support as being the most important aspect of EoLC that they provide, but there were barriers to its provision. GPs felt most comfortable treating pain, and least confident with dyspnoea and depression. Observed pain management was sometimes not optimal. More formal training, particularly in the use of opioids was considered important to improve management of both pain and dyspnoea.Conclusions It is essential that GPs receive regular education and training, and exposure to EoLC from an early stage in their careers to ensure skill and confidence. Research into the role of GPNs in symptom control needs to occur.

AB - Background End of life care (EoLC) is a fundamental role of general practice, which will become more important as the population ages. It is essential that general practice’s role and performance of at the end of life is understood in order to maximise the skills of the entire workforce.Objective To provide a comprehensive description of the role and performance of general practitioners (GPs) and general practice nurses (GPNs) in EoLC symptom control.Method Systematic literature review of papers from 2000 to 2017 were sought from Medline, PsycINFO, Embase, Joanna Briggs Institute and Cochrane databases.Results From 6209 journal articles, 46 papers reported GP performance in symptom management. There was no reference to the performance of GPNs in any paper identified. Most GPs expressed confidence in identifying EoLC symptoms. However, they reported lack of confidence in providing EoLC at the beginning of their careers, and improvements with time in practice. They perceived emotional support as being the most important aspect of EoLC that they provide, but there were barriers to its provision. GPs felt most comfortable treating pain, and least confident with dyspnoea and depression. Observed pain management was sometimes not optimal. More formal training, particularly in the use of opioids was considered important to improve management of both pain and dyspnoea.Conclusions It is essential that GPs receive regular education and training, and exposure to EoLC from an early stage in their careers to ensure skill and confidence. Research into the role of GPNs in symptom control needs to occur.

U2 - 10.1136/bmjspcare-2017-001374

DO - 10.1136/bmjspcare-2017-001374

M3 - Review Article

VL - 8

SP - 411

EP - 420

JO - BMJ Supportive and Palliative Care

JF - BMJ Supportive and Palliative Care

SN - 2045-435X

IS - 4

ER -