BackgroundWith increasing numbers of people living with complex life-limiting multimorbidity in the community, consideration must be given to improving the organisation and delivery of highquality palliative and end-of-life care (EOLC). AimTo provide insight into the experience of GPs providing EOLC in the community, particularly the facilitators and barriers to good-quality care. Design and settingA web-based national UK questionnaire survey circulated via the Royal College of General Practitioners, NHS, Marie Curie, and Macmillan networks to GPs. MethodResponses were analysed using descriptive statistics and an inductive thematic analysis. ResultsResponses were received from 516 GPs, who were widely distributed in terms of practice location. Of these, 97% felt that general practice plays a key role in the delivery of care to people approaching the end of life and their families. Four interdependent themes emerged from the data: continuity of care -which can be difficult to achieve because of resource concerns including time, staff numbers, increasing primary care workload, and lack of funding; patient and family factors -with challenges including early identification of palliative care needs and recognition of the end of life, opportunity for care planning discussions, and provision of support for families; medical management -including effective symptomcontrol and access to specialist palliative care services; and expertise and training -the need for training and professional development was recognised to enhance knowledge, skills, and attitudes towards EOLC. ConclusionThe findings reveal enduring priorities for policy, commissioning, practice development, and research in future primary palliative care.
Background Family and other unpaid carers are crucial to supporting the growing population of older people that are living outside residential care with frailty and comorbidities. The burden associated with caring affects carers’ well-being, thus limiting the sustainability of such care. There is a need for accessible, flexible, and responsive interventions that promote carers’ coping and resilience, and hence support maintenance of the health, well-being, and independence of the cared-for person. Objective This study aimed to coproduce a digital program for carers to promote resilience and coping through supporting effective use of information and other Web-based resources. Its overlapping stages comprised the following: understanding the ways in which Web-based interventions may address challenges faced by carers, identifying target behaviors for the intervention, identifying intervention components, and developing the intervention prototype. Methods The study was informed by person-based theories of coproduction and involved substantial patient and public involvement. It drew on the Behavior Change Wheel framework to support a systematic focus on behavioral issues relevant to caring. It comprised scoping literature reviews, interviews, and focus groups with carers and organizational stakeholders, and an agile, lean approach to information technology development. Qualitative data were analyzed using a thematic approach. Results Four behavioral challenges were identified: burden of care, lack of knowledge, self-efficacy, and lack of time. Local health and social care services for carers were only being accessed by a minority of carers. Carers appreciated the potential value of Web-based resources but described difficulty identifying reliable information at times of need. Key aspects of behavior change relevant to addressing these challenges were education (increasing knowledge and understanding), enablement (increasing means and reducing barriers for undertaking caring roles), and persuasion (changing beliefs and encouraging action toward active use of the intervention). In collaboration with carers, this was used to define requirements for the program. A resources library was created to link to websites, Web-based guidance, videos, and other material that addressed condition-specific and generic information. Each resource was classified according to a taxonomy itemizing over 30 different subcategories of need under the headings Care Needs (of the cared-for person), General Information and Advice, and Sustaining the Carer. In addition, features such as a journal and mood monitor were incorporated to address other enablement challenges. The need for proactive, personalized prompts emerged; the program regularly prompts the carer to revisit and update their profile, which, together with their previous use of the intervention, drives notifications about resources and actions that may be...
Background: Due to poor continuity of care between child and adult mental health services, young people (YP) are often discharged to their GP when they reach the upper boundary of child and adolescent mental health services (CAMHS). This handover of care, however, is poorly managed and GPs can struggle to support YP without input from specialist services. Little is known about YP’s experiences of accessing mental health support from their GP after leaving CAMHS. Aim: To explore the experiences of YP receiving primary care support after CAMHS for their mental health, and to identify barriers and facilitators to accessing primary care. Design and Setting: A qualitative study with YP and parents across two counties in England. Method: Narrative interviews were conducted with 14 YP and 13 parents who had experienced poor continuity of care after reaching their CAMHS transition boundary. Data were analysed using reflexive thematic analysis. Results: Three themes were identified: unmet mental health needs, disjointed care, and taking responsibility. YP who described positive experiences were more likely to have a long-term relationship with their GP and found their GP made time to understand their needs and experiences. Barriers included the perception that GPs were unable to prescribe certain medication, anxiety caused by the general practice environment, and having to move to a new practice at university. Conclusion: Future research should focus on interventions which improve continuity of care for YP after leaving CAMHS and collaborative working across community mental health services.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.