Factors influencing GPs’ perception of specialised palliative homecare (SPHC) importance – results of a cross-sectional study

Abstract

Background: General Practitioners (GPs) are the main providers of primary palliative care (PPC). At the same time they are the main initiators of specialised palliative homecare (SPHC). In Germany, little is known about factors which influence GPs in their involvement of SPHC. Aim of our study is to identify factors that drive GPs to give value to and involve SPHC. Methods: A cross-sectional survey was performed. In 2018, questionnaires were mailed to 6000 randomly selected GPs from eight German federal states, focusing on the extent of GPs' palliative care activities and their involvement of SPHC. Results: With a response rate of 19.4% and exclusion of GPs working in SPHC-teams, n = 1026 questionnaires were appropriate for analysis. GPs valued SPHC support as the most "important/very important" for both "technical/ invasive treatment measures" (95%) and availability outside practice opening hours (92%). The most relevant factor influencing perceived SPHC-importance was GPs' self-reported extent of engagement in palliative care (β = − 0.283; CI 95% = − 0.384;−0.182), followed by the perceived quality of utilised SPHC (β = 0.119; CI 95% = 0.048;0.190), involvement in treatment of palliative patients after SPHC initiation (β = 0.088; CI 95% = 0.042; 0.134), and conviction that palliative care should be a central part of GPs' work (β = − 0.062; CI 95% = − 0.116; −0.008). Perceived SPHC-importance is also associated with SPHC-referrals (β =0.138; p < 0.001). The lower the engagement of GPs in palliative care, the more they involve SPHC and vice versa. Conclusions: GPs with low reported activity in palliative care are more likely to initialise SPHC for palliative care activities they do not deliver themselves for various reasons, which might mean that the involvement of SPHC is substitutive instead of complementary to primary palliative care. This finding and its interpretation should be given more attention in the future policy framework for (specialised) palliative homecare.

Palliativversorgung am Lebensende in Deutschland

“…Für die jeweilige Entscheidung, ob AAPV oder SAPV zum Einsatz kommt, liegen Hinweise vor, dass diese in hohem Maße von den verfügbaren hausärztlichen AAPV-Kapazitäten abhängt [ 22 ]. Weitere Faktoren zur Erklärung regionalspezifischer Inanspruchnahmemuster sollen im Folgenden für ausgewählte KV-Regionen mit niedriger bzw.…”

Effectiveness of two types of palliative home care in cancer and non-cancer patients: A retrospective population-based study using claims data

“…2 , 3 At the same time, it is evident that specialized palliative homecare does not only depend on the patient’s medical need (and demand) but also on surrounding factors that can impede the involvement of primary palliative care alone, such as the available palliative care infrastructure, as well as the high workload of general practitioners. 4 Therefore, it is valuable to compare the impact of primary palliative care and specialized palliative homecare in end-of-life care.…”

Ultrasound use in metastatic breast cancer to measure body composition changes following an exercise intervention

“…On the one hand, previous literature has shown that exercise interventions preserve physical function in prostate cancer patients with bone metastases. Compared with the control group, patients showed function improvements measured by PRO and functional tests after 3 months 32 . Specifically, 5 out of our 13 patients had bone metastasis in the femur.…”

“…On the other hand, to guarantee safety, exercise adaptations may have limited possible changes in muscle architecture, as a high load is required for a hypertrophic response 55 . In this regard, literature concerning exercise intervention in patients with bone metastases is quite limited to exercise feasibility, avoiding affected areas 32 or at low intensities 50 given the risk of fracture 56 . Another factor that may have influence changes in muscle mass is cancer treatment and cancer itself, as they induce muscular adaptations that counteract those induced by exercise training 57 .…”

“…Intensity, time, and time prescriptions were individualized based on evaluations of muscular strength, endurance, and patient's needs 31 . In the case of bone metastasis, adaptations were made to avoid specific loading sites 32 . Also, current recommendations in the field of oncology exercise were taken into account 20 .…”