Quality of end-of-life care in general practice – a pre–post comparison of a two-tiered intervention

Abstract

Background General practitioners (GPs) play a crucial role in the provision of end-of-life care (EoLC). The present study aimed at comparing the quality of GPs’ EoLC before and after an intervention involving a clinical decision aid and a public campaign. Methods The study was part of the larger interventional study ‘Optimal care at the end of life’ (OPAL) (Innovation Fund, Grant No. 01VSF17028). The intervention lasted 12 months and comprised two components: (1) implementation of the Supportive and Palliative Care Indicators Tool (SPICT-DE™) in general practice and (2) a public campaign in two German counties to inform and connect regional health care providers and stakeholders in EoLC. Participating GPs completed the General Practice End of Life Care Index (GP-EoLC-I) pre- (t0) and post- (t1) intervention. The GP-EoLC-I (25 items, score range: 14–40) is a self-assessment questionnaire that measures the quality of GPs’ EoLC. It includes two subscales: practice organisation and clinical practice. Data were analysed descriptively, and a paired t-test was applied for the pre–post comparison. Results Forty-five GPs (female: 29%, median age: 57 years) from 33 general practices participated in the intervention and took part in the survey at both times of measurement (t0 and t1). The mean GP-EoLC-I score (t0 = 27.9; t1 = 29.8) increased significantly by 1.9 points between t0 and t1 (t(44) = − 3.0; p = 0.005). Scores on the practice organisation subscale (t0 = 6.9; t1 = 7.6) remained almost similar (t(44) = -2.0; p = 0.057), whereas those of the clinical practice subscale (t0 = 21.0; t1 = 22.2) changed significantly between t0 and t1 (t(44) = -2.6; p = 0.011). In particular, items regarding the record of care plans, patients’ preferred place of care at the end of life and patients’ preferred place of death, as well as the routine documentation of impending death, changed positively. Conclusions GPs’ self-assessed quality of EoLC seemed to improve after a regional intervention that involved both the implementation of the SPICT-DE™ in daily practice and a public campaign. In particular, improvement related to the domains of care planning and documentation. Trial registration The study was registered in the German Clinical Trials Register (DRKS00015108; 22/01/2019).

Use of the supportive and palliative care indicators tool (SPICT™) for end-of-life discussions: a scoping review

“…There were multiple study designs including validation and translation ( n = 8) studies [ 20 – 27 ] and clinical improvement projects ( n = 3) [ 28 – 30 ]. The focus of the clinical improvement projects was to increase the identification of palliative care needs and care planning through the use of the SPICT™.…”

“…Ten of the included studies were conducted in primary care and general practice settings 20 – 22 24 25 30 – 32 37 38 . The SPICT™ was also used in outpatient clinic settings 23 28 39 and residential aged care 29 35 .…”

“…Of the included records ten were studies conducted in European countries 20 – 22 24 30 – 33 37 38 ; seven in Asia 23 25 27 39 – 42 ; three in the USA 28 29 36 ; two in Australia 34 35 ; one in South Africa [ 43 ] one in Chile [ 26 ] and one in Peru [ 44 ], and one paper was a review performed by authors based in Switzerland [ 18 ]. Of note the systematic review and survey of European primary care GP practice to identify patients for palliative care revealed that the United Kingdom was the only European country at the time that incorporated the SPICT™ to identify palliative care needs in primary and secondary care in clinical guidelines [ 31 ].…”

“…There is evidence that the SPICT™ by virtue of assisting clinicians to discuss end of life care facilitates changes in documented goals of care. Specifically this was demonstrated in a pre-post intervention study in which GPs trained in palliative care and the use of the SPICT-DE™ were requested to use it in their everyday practice for 12 months with every adult patient diagnosed with a chronic, progressive disease [ 30 ]. This occurred concurrently with a public campaign focused on informing health care providers and stake holders in two counties in Germany about end-of-life care.…”

“…Records of care planning increased from 33 to 51% and documentation of preferred place of death towards the end-of-life increased from 20 to 33% and patients’ wishes, and spiritual beliefs increased from 18 to 27%. Incidentally GPs’ self-reported quality of end-of-life care increased after the implementation of the SPICT-DE™ and the information campaign [ 30 ].…”