General practice palliative care: patient and carer expectations, advance care plans and place of death—a systematic review

Abstract

Patients and carers prefer a holistic approach to care. This review shows that GPs have an important role in ACP and that their involvement facilitates dying in the place of preference. Proactive identification of people approaching EoL is likely to improve all aspects of care, including planning and communicating about EoL. More work outlining the role of GPNs in end of life care is required.

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

“…While our study focused on the experiences of patients, carers and GPs residing in rural areas of Western Australia, and only included patients who were not cognitively impaired, it limits the transferability of our findings to other populations. However, the data reflect findings in similar studies of patient and GP perceptions of care in other populations (Johnson et al., 2018). Furthermore, patients were recruited through the Cancer Council Support Services.…”

“…Symptom control was reportedly difficult to achieve sometimes for patients in our study, highlighting the need for a skilled GP workforce, as well as a multidisciplinary approach to care in the community (Johnson et al., 2018). Participants identified the importance of highly interactive specialist palliative care health professionals to provide support and expertise, either contributing directly to patient care or providing input on a consultative basis.…”

“…People diagnosed with cancer often have complex physical and psycho‐social care needs as they approach EOL. Optimal EOL care in rural communities requires a commitment of time, skill and self on the part of the GP (Johnson et al., 2018), and a multi‐professional approach from within the local community. With a strong foundation of interpersonal/professional communication, organisation and planning of care in advance, we have shown that it is not beyond the resources of rural and regional GPs and communities to provide EOL care that meets the needs of many people dying with cancer.…”

Features of U.S. Primary Care Physicians and Their Practices Associated with Advance Care Planning Conversations

“…30 ACP conversations can help support decision-making by specifying the domains of suffering or quality of life that patients experience along their chronic illness trajectories. 29 From a policy perspective, the routine incorporation of ACP facilitates care that meets the triple aim-improving patient experience through improving patient satisfaction, 3,31 improving population health by reducing caregiver distress, 31 and reducing per capita health care costs by creating care plans allowing patients to avoid hospitalizations when their goals are to remain at home. 2,3 The specific role that ACP conversations may have in the move toward value and quality-based primary health care delivery is currently unknown, but efforts are currently planned to evaluate their impact on quality and costs.…”

“…decreasing use of life-sustaining treatments, reducing hospitalizations, increasing use of hospice and palliative services, and leading to care consistent with patient end-of-life wishes. 2,3 Primary care is the foundation of models for quality patient-centered health care and is a natural venue for ACP engagement. 4 -6 People with a consistent source for care, such as those with a primary care provider (PCP), report higher levels of ACP document completion.…”