Palliative care in general practice; a questionnaire study on the GPs role and guideline implementation in Norway

Fasting, Anne; Hetlevik, Irene; Mjølstad, Bente Prytz

doi:10.1186/s12875-021-01426-8

Cited by 10 publications

(15 citation statements)

References 29 publications

(18 reference statements)

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“…The tendency for rural GPs to be more involved than urban GPs in palliative care must be interpreted with caution due to our sample size. This is, however, in line with our previous questionnaire study, showing that rural GPs to a larger degree reported to be central in palliative care [ 25 ]. In an Australian study, rural and remote GPs were found to have more responsibility for their palliative patients and less support from the PCTs than their urban colleagues [ 40 ].…”

Section: Discussionsupporting

confidence: 92%

“…In Norway, although conforming to national legislation, the practical organization of primary care in different municipalities varies, and steps to accommodate for a longer travel distance from the hospital may be appropriate. For the hospital specialists, however, our findings seem like a departure from the ideal of equality of services, strengthening our suggestion of unwarranted variation in the specialist service provision from the findings in our previous study [ 25 ]. These connections may need further investigation.…”

Section: Discussionsupporting

confidence: 82%

“…GPs are described as missing in the palliative care trajectories, and difficult to integrate into the palliative care networks in primary care [ 23 , 24 ]. We previously conducted a questionnaire study of GPs in Norway, finding that most GPs had few palliative patients at a time and that being involved in home death was a rare event, limiting their possibility of learning and maintaining complex skills and knowledge of palliative care [ 25 ]. Yet, about half of the RGPs saw themselves as central in providing palliative care in the primary care setting, challenging the prevailing views of the Norwegian GPs’ as “missing” or uninterested in palliative care [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

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Finding their place – general practitioners' experiences with palliative care—a Norwegian qualitative study

2022

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Background Modern palliative care focuses on enabling patients to spend their remaining time at home, and dying comfortably at home, for those patients who want it. Compared to many European countries, few die at home in Norway. General practitioners’ (GPs’) involvement in palliative care may increase patients’ time at home and achievements of home death. Norwegian GPs are perceived as missing in this work. The aim of this study is to explore GPs’ experiences in palliative care regarding their involvement in this work, how they define their role, and what they think they realistically can contribute towards palliative patients. Methods We performed focus group interviews with GPs, following a semi-structured interview guide. We included four focus groups with a total of 25 GPs. Interviews were recorded and transcribed verbatim. We performed qualitative analysis on these interviews, inspired by interpretative phenomenological analysis. Results Strengths of the GP in the provision of palliative care consisted of characteristics of general practice and skills they relied on, such as general medical knowledge, being coordinator of care, and having a personal and longitudinal knowledge of the patient and a family perspective. They generally had positive attitudes but differing views about their formal role, which was described along three positions towards palliative care: the highly involved, the weakly involved, and the uninvolved GP. Conclusion GPs have evident strengths that could be important in the provision of palliative care. They rely on general medical knowledge and need specialist support. They had no consensus about their role in palliative care. Multiple factors interact in complex ways to determine how the GPs perceive their role and how involved they are in palliative care. GPs may possess skills and knowledge complementary to the specialized skills of palliative care team physicians. Specialized teams with extensive outreach activities should be aware of the potential they have for both enabling and deskilling GPs.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

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Finding their place – general practitioners' experiences with palliative care—a Norwegian qualitative study

2022

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“…In a previous paper from this study, we found that there were unfortunate variations in palliative knowledge and skills among GPs [ 19 ]. This could be because each GP has few patients needing palliative care and limited experience could make it difficult to maintain knowledge and skills [ 31 ]. In addition, some patients continue to be followed up by specialist palliative care even after discharge, especially if they live close to a hospital [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Talking together in rural palliative care: a qualitative study of interprofessional collaboration in Norway

Johansen

Ervik

2022

BMC Health Serv Res

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Background Caring for people with palliative care needs in their homes requires close collaboration within and between primary and hospital care. However, such close collaboration is often lacking. Transitions of care are potentially unsafe and distressing points in a patient trajectory. Few studies have explored the experiences of healthcare professionals in the community who receive patients from hospital care and provide them with palliative care at home. Objective To explore how rural health professionals experience local and regional collaboration on patients in need of palliative care. Methods This was a qualitative focus group and interview study in rural Northern Norway involving 52 primary care health professionals including district nurses, general practitioners, oncology nurses, physiotherapists, and occupational therapists. Five uni-professional focus group discussions were followed by five interprofessional discussions and six individual interviews. Transcripts were analysed thematically. Results “Talking together” was perceived as the optimal form of collaboration, both within primary care and with specialists. Nurses and GPs had similar perceptions of their worst-case scenario in primary palliative care: the sudden arrival after working hours of a sick patient about whom they lacked information. These situations could be the result of a short notice transfer from secondary care or an emergency presentation after a crisis in patient management locally, the latter often resulting in a hospital admission. Participants missed timely and detailed discharge letters and in complex cases a telephone call or conference. Locally, co-location was perceived as advantageous for crucial communication, mutual support, and knowledge about each other’s competencies and work schedule. Because local health professionals belonged to different units within the primary health care organisation, in some places they had limited knowledge about each other’s roles and skill sets. Conclusions Lack of communication, both locally and between specialist and primary care, was a key factor in the worst-case patient scenarios for GPs and nurses working in primary palliative care in rural Northern Norway. Co-location of primary care professionals promoted local collaboration and should be encouraged. Hospital discharge planning should involve the receiving primary care professionals.

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“…In Switzerland and Norway, a study found low overall adherence to current practice guidelines and high variation in the use of nutritional therapy in patients undergoing stem cell transplantation [ 11 ]. A study carried out in Norway showed low adherence of regular general practitioners to the palliative care guideline [ 12 ]. In the management of osteoarthritis, studies suggest that the main approaches recommended in the guidelines are underutilized and that the quality of care is inconsistent [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Strategies for the implementation of clinical practice guidelines in public health: an overview of systematic reviews

Pereira

Silva

Carvalho

et al. 2022

Health Res Policy Sys

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Background As a source of readily available evidence, rigorously synthesized and interpreted by expert clinicians and methodologists, clinical guidelines are part of an evidence-based practice toolkit, which, transformed into practice recommendations, have the potential to improve both the process of care and patient outcomes. In Brazil, the process of development and updating of the clinical guidelines for the Brazilian Unified Health System (Sistema Único de Saúde, SUS) is already well systematized by the Ministry of Health. However, the implementation process of those guidelines has not yet been discussed and well structured. Therefore, the first step of this project and the primary objective of this study was to summarize the evidence on the effectiveness of strategies used to promote clinical practice guideline implementation and dissemination. Methods This overview used systematic review methodology to locate and evaluate published systematic reviews regarding strategies for clinical practice guideline implementation and adhered to the PRISMA guidelines for systematic review (PRISMA). Results This overview identified 36 systematic reviews regarding 30 strategies targeting healthcare organizations, healthcare providers and patients to promote guideline implementation. The most reported interventions were educational materials, educational meetings, reminders, academic detailing and audit and feedback. Care pathways—single intervention, educational meeting—single intervention, organizational culture, and audit and feedback—both strategies implemented in combination with others—were strategies categorized as generally effective from the systematic reviews. In the meta-analyses, when used alone, organizational culture, educational intervention and reminders proved to be effective in promoting physicians' adherence to the guidelines. When used in conjunction with other strategies, organizational culture also proved to be effective. For patient-related outcomes, education intervention showed effective results for disease target results at a short and long term. Conclusion This overview provides a broad summary of the best evidence on guideline implementation. Even if the included literature highlights the various limitations related to the lack of standardization, the methodological quality of the studies, and especially the lack of conclusion about the superiority of one strategy over another, the summary of the results provided by this study provides information on strategies that have been most widely studied in the last few years and their effectiveness in the context in which they were applied. Therefore, this panorama can support strategy decision-making adequate for SUS and other health systems, seeking to positively impact on the appropriate use of guidelines, healthcare outcomes and the sustainability of the SUS.

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Palliative care in general practice; a questionnaire study on the GPs role and guideline implementation in Norway

Cited by 10 publications

References 29 publications

Finding their place – general practitioners' experiences with palliative care—a Norwegian qualitative study

Finding their place – general practitioners' experiences with palliative care—a Norwegian qualitative study

Talking together in rural palliative care: a qualitative study of interprofessional collaboration in Norway

Strategies for the implementation of clinical practice guidelines in public health: an overview of systematic reviews

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