Australian General Practitioners' and Oncology Specialists' Perceptions of Barriers and Facilitators of Access to Specialist Palliative Care Services

2011 ◽  
Vol 14 (4) ◽  
pp. 429-435 ◽  
Author(s):  
Claire Johnson ◽  
Chris Paul ◽  
Afaf Girgis ◽  
Jon Adams ◽  
David C. Currow
Keyword(s):  
Palliative Care ◽  
General Practitioners ◽  
Barriers And Facilitators ◽  
Specialist Palliative Care ◽  
Care Services ◽  
Palliative Care Services

Managing Severe Chronic Breathlessness in Chronic Obstructive Pulmonary Disease Is Challenging for General Practitioners

2020 ◽  
pp. 104990912095906
Author(s):  
John Politis ◽  
Peter Eastman ◽  
Brian Le ◽  
John Furler ◽  
Louis Irving ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Palliative Care ◽  
Pulmonary Disease ◽  
General Practitioners ◽  
Chronic Obstructive ◽  
Specialist Palliative Care ◽  
Obstructive Pulmonary Disease ◽  
Care Services ◽  
Palliative Care Services ◽  
Severe Copd

Context: Patients with advanced chronic obstructive pulmonary disease (COPD) can develop increasing breathlessness, which can persist despite optimal medical management—refractory breathlessness. Management can be challenging for all clinicians and requires a broad approach that includes optimization of disease directed therapies, non-pharmacological strategies to manage breathlessness and for some patients opioids. Objectives: To explore the approaches to breathlessness management and palliative care undertaken by Australian General Practitioners (GP) for patients with severe COPD and refractory breathlessness. Methods: A case-vignette based survey was conducted with Australian GPs to determine their approaches to breathlessness management and palliative care in COPD. Results: Of the 137 GPs, 66% recommended commencing an additional medication to manage refractory breathlessness. Thirty-eight GPs (28%) recommended opioids and 26 (19%) recommended guideline discordant treatments. Two-thirds of GPs had concerns regarding the use of opioids in COPD. Half (55%) of GPs were comfortable providing general palliative care to patients with COPD and 62 (45%) had referred patients with COPD to specialist palliative care services. Most respondents wanted further training to manage severe COPD and severe chronic breathlessness. Conclusion: Most GPs recognized and were willing to add specific treatments for severe chronic breathlessness. However, experience prescribing opioids for severe chronic breathlessness was low, with many practitioners holding significant concerns regarding adverse effects. Many GPs are uncomfortable offering a palliative approach to their COPD patients, yet these patients are not routinely referred to specialist palliative care services despite their immense needs. GPs therefore desire education and support to overcome these barriers.

scholarly journals Service change and innovation in community end-of-life care during the COVID-19 pandemic: Qualitative analysis of a nationwide primary care survey

2021 ◽  
pp. 026921632110493
Author(s):  
Sarah Mitchell ◽  
Madeleine Harrison ◽  
Phillip Oliver ◽  
Clare Gardiner ◽  
Helen Chapman ◽  
...  
Keyword(s):  
Primary Care ◽  
Palliative Care ◽  
United Kingdom ◽  
End Of Life ◽  
General Practitioners ◽  
End Of Life Care ◽  
Life Care ◽  
Specialist Palliative Care ◽  
Care Services ◽  
Palliative Care Services

Background: Primary healthcare teams (general practice and community nursing services) within the United Kingdom provided the majority of community end-of-life care during COVID-19, alongside specialist palliative care services. As international healthcare systems move to a period of restoration following the first phases of the pandemic, the impact of rapidly-implemented service changes and innovations across primary and specialist palliative care services must be understood. Aim: To provide detailed insights and understanding into service changes and innovation that occurred in UK primary care to deliver end-of-life care during the first phase of the COVID-19 pandemic. Design: Cross-sectional online survey. Responses were analysed using descriptive statistics and thematic analysis. Setting/participants: United Kingdom survey of general practitioners and community nurses, circulated via regional and national professional networks. Results: A total of 559 valid responses were received from 387 community nurses, 156 general practitioners and 16 ‘other’. Over a third of respondents ( n = 224; 40.8%) experienced changes in the organisation of their team in order to provide end-of-life care in response to the COVID-19 pandemic. Three qualitative themes were identified: COVID-19 as a catalyst for change in primary palliative care; new opportunities for more responsive and technological ways of working; and pandemic factors that improved and strengthened interprofessional collaboration. Conclusion: Opportunity has arisen to incorporate cross-boundary service changes and innovations, implemented rapidly at the time of crisis, into future service delivery. Future research should focus on which service changes and innovations provide the most benefits, who for and how, within the context of increased patient need and complexity.

scholarly journals Specialist palliative care services for older people in primary care: A systematic review using narrative synthesis

2019 ◽  
Vol 34 (1) ◽  
pp. 32-48 ◽  
Author(s):  
Kim de Nooijer ◽  
Yolanda WH Penders ◽  
Lara Pivodic ◽  
Nele J Van Den Noortgate ◽  
Peter Pype ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Palliative Care ◽  
Older People ◽  
Narrative Synthesis ◽  
Specialist Palliative Care ◽  
Family Carers ◽  
Care Services ◽  
Specialist Services ◽  
Palliative Care Services

Background: There is recognition that older people with incurable conditions should have access to specialist palliative care services. However, it remains unclear which activities and outcomes these services entail for older people in primary care and to which patients they are provided. Aim: The aim of this review was to identify the criteria for referral to specialist services; who provides specialist palliative care; through which activities and with which frequency; which outcomes are reported; and which suggestions are made to improve services. Design: Systematic review of the literature and narrative synthesis. Quality appraisal and selection of studies were performed independently by two researchers. Participant characteristics, intervention features, outcome data and suggestions for improvement were retrieved. Data sources: Embase, Medline, Web of Science, Cochrane, Google Scholar, PsycINFO and CINAHL EBSCO databases (until June 2019). Results: Ten eligible articles, three qualitative, three quantitative, three mixed-method and one narrative review, were identified. Referral criteria were mainly based on patient characteristics such as diagnosis. The specialist services involved a variety of activities and outcomes and descriptions were often lacking. Services could be improved regarding the information flow between healthcare professionals, greater in-depth palliative care knowledge for case managers and social workers, identification of a key worker and support for family carers. Conclusion: The limited evidence available shows areas for improvement of the quality of and access to specialist services for older people, such as support for family carers. In addition, this review underscores the need for comprehensive reporting of interventions and the use of consensus-based outcome measures.

Mind the gap: do tertiary cancer centres need 24 hour access to specialist palliative care services?

2012 ◽  
Vol 2 (Suppl 1) ◽  
pp. A78.1-A78
Author(s):  
Owen Pooley ◽  
Alison Coackley ◽  
Agnes Noble ◽  
Ann Griffiths ◽  
Donna Arundell
Keyword(s):  
Palliative Care ◽  
Specialist Palliative Care ◽  
Care Services ◽  
Palliative Care Services

Issues for General Practitioners Caring for Dying Patients in the Home

1999 ◽  
Vol 5 (2) ◽  
pp. 9 ◽  
Author(s):  
Annette Street ◽  
Jeanine Blackford ◽  
Anne Turley ◽  
Judy Kelso
Keyword(s):  
Palliative Care ◽  
General Practitioners ◽  
Terminally Ill ◽  
Team Approach ◽  
Fee For Service ◽  
Quality Health Care ◽  
Care Services ◽  
Dying Patients ◽  
Palliative Care Services ◽  
Counselling Program

General practitioners have a central role in the provision of quality health care to the terminally ill patient and family in their own homes. Staff from the Department of Human Services were concerned that GPs were experiencing stress through their increasing role in the provision of palliative care and that there was a need for a fee-for-service stress counselling program for them. A small qualitative study was conducted to verify this perceived need. Semi-structured telephone interviews were conducted with 50 GPs selected from a sample of metropolitan attendees at postgraduate educational activities or doctors known to palliative care services. GPs faced a number of issues in their care for terminally ill people in the community but a fee-for-service counselling program was deemed unnecessary. Evidence from the study confirmed that effective communication strategies between GPs, palliative care services and acute hospitals, an interdisciplinary team approach, and improved understanding between health professionals would enhance the quality of care for dying people and their caregivers.

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