Timely identification of palliative patients and anticipatory care planning by GPs: practical application of tools and a training programme

Abstract

BackgroundPalliative care is mainly restricted to terminal care. General practitioners (GPs) are not trained to early identify palliative patients with cancer, COPD or heart failure. With the help of the RADboud indicators for PAlliative Care needs (RADPAC), we trained GPs to identify patients’ needs and to make a proactive care plan. They were also able to join two role-plays where they discussed the patient’s future, and consulted a palliative care consultant to fine-tune the care plan. We evaluated the programme with the GPs and consultants and noted its impact on their daily practice.MethodsTwo years after they had participated in the programme, we held semi-structured interviews with the GPs and a focus group interview with the consultants and performed a thematic content analysis.ResultsSix consultants and nine GPs participated in the programme. Most GPs and consultants mentioned positive changes in the thinking or acting of GPs regarding early palliative care. A number continued to use the tool to identify patients; most of the others noted they had internalised the indicators. Although half of them still considered discussing end-of-life aspects difficult, particularly in patients with organ failure, the others were more easily able to discuss the future with their palliative patients.ConclusionAlthough most GPs and consultants were positive about the training programme and applying it in daily practice, we conclude that in future programmes, more attention needs to paid to timely identification of palliative patients with COPD or CHF and how to discuss the future with them.

Advance care planning conversations with palliative patients: looking through the GP’s eyes

“…Like others, we found that GPs find it hard to identify and discuss palliative care needs with patients with organ failure [ 23 , 34 ]. Moreover, our finding that initiating ACP is difficult when patients are still being treated in hospital is also confirmed in other literature [ 35 – 37 ]. It was mentioned in our study that ‘it is not ideal to ask about their wishes when something happens, i.e.…”

Feasibility of hospital-initiated non-facilitator assisted advance care planning documentation for patients with palliative care needs

“…The ACP document consists of four separate single-page forms: (1) patient information including an overview of a patient’s advance directives; (2) an advance care plan stating anticipated future problems and an overview of all professional carers involved and how and when to contact them; (3) a current and recently discontinued medication overview and (4) a description of a patient’s current problems in all palliative domains: physical and care-related, social (including financial), psychological, and spiritual [ 21 ].…”

“…Because of the availability nowadays of a range of palliative treatments (e.g. surgery, chemotherapy, immunotherapy, advanced heart failure therapy), patients are treated at the hospital longer than they used to be, falling outside of the scope of the general practitioner (GP), traditionally the doctor to deliver palliative care [ 19 – 21 ]. Moreover, palliative patients are identified as such earlier on in their disease process.…”

Home-based palliative care management: what are the useful resources for general practitioners? a qualitative study among GPs in France

“…At first sight, this finding seems contradictory with existing data. Indeed, Thoonsen et al [ 6 , 51 , 52 ] have shown that training GPs makes them more easily able to discuss the future with their palliative patients, to identify more palliative patients and to provide multidimensional palliative care more often. Actually, these data are complementary since the training studied by Thoonsen et al aimed not only at providing knowledge but also skills and self-efficacy.…”