End-of-life care in rural general practice: how best to support commitment and meet challenges?

Abstract

Background: Few studies have specifically assessed the scope, nature and challenges of palliative and end-of-life care in rural general practice. These knowledge gaps limit the development of evidence-based policies and services for patients in the last months of life. This study aimed to explore the perspectives of general practitioners (GPs) and other stakeholders on rural GPs' involvement and challenges in providing palliative and end-of-life care in regional Australia. Methods: A qualitative study involving five focus groups with 26 GPs based in rural/regional Western Australia together with 15 individual telephone interviews with four GPs and 11 other stakeholders involved in end-of-life care across Australia. Results: The rural GPs' central role in end-of-life care was recognized by the majority of participants but multiple challenges were also identified. Some challenges were comparable to those found in urban settings but others were more pronounced, including resource limitations and lack of training. Inappropriate payment models discouraged GPs' involvement in some aspects of end-of-life care, such as case conferences and home visits. Compared to GPs in urban settings, those in rural/regional communities often reported closer doctor-patient relationships and better care integration and collaboration. These positive aspects of care could be further developed to enhance service provision. Our study highlighted the importance of regular interactions with other professionals and patients in providing end-of-life care, but many GPs and other stakeholders found such interactions more challenging than the more "technical" aspects of care. Conclusions: Rural/regional GPs appear to be disproportionately affected by inappropriate payment models and limited resources, but may benefit from closer doctor-patient relationships and better care integration and collaboration relative to urban GPs. Systematic collection of empirical data on GP management at end-of-life is required to build on these strengths and address the challenges.

Symptom Burden and Palliative Care Needs of Patients with Incurable Cancer at Diagnosis and During the Disease Course

“…Additionally, other studies described that effects depend on the psychosocial, cultural and ethical background of patients, their family situation and place of residence (e.g. urban versus rural areas) [18][19][20].…”

End-of-life care in general practice: clinic-based data collection

“…The item pool was informed by a systematic review11 of previous assessment tools of palliative and end-of-life care in general practice plus interviews with 30 GPs and 11 other stakeholders 12…”

“…Most people die from conditions that have some degree of predictability but which are rarely the focus of specialist palliative care, such as multimorbidity, frailty and dementia 10. Our previous studies have identified that GPs are highly involved in palliative and end-of-life care but face multiple challenges in delivering this care 11–14. Lack of empirical data on the quality and nature of end-of-life care in general practice has restricted our capacity to address the major issues experienced by GPs.…”

End‐of‐life care in rural and regional Australia: Patients’, carers’ and general practitioners’ expectations of the role of general practice, and the degree to which they were met

“…Of concern for collaborating health professionals, consumers and policy makers is how well rural GPs are providing palliative and EOL care, and what can be done to maximise the effectiveness of their care for people at the EOL and their informal carers in Australia (Ding, Saunders, Cook, & Johnson, 2019) and other countries (Chukwusa et al., 2019; Conlon et al., 2019; Isaacson & Lynch, 2017; Leng, Jing, Nicholas, & Wang, 2019; Warraich et al., 2019). Prior to the development of interventions to support GPs and consumers, it is necessary to identify the attributes of EOL care and current gaps in service delivery within rural settings.…”