Training general practitioners contributes to the identification of palliative patients and to multidimensional care provision: secondary outcomes of an RCT

Thoonsen, Bregje; Gerritzen, Stefanie H M; Vissers, Kris; Verhagen, Stans; Weel, Chris van; Groot, Marieke; Engels, Yvonne

doi:10.1136/bmjspcare-2015-001031

Cited by 26 publications

(29 citation statements)

References 34 publications

(31 reference statements)

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“…Communication has been mentioned before as a barrier for the early initiation of PC ( 8 , 9 , 31 ). The positive opinions regarding the PS are mirrored by recent research by Thoonsen et al, in which GPs stated that this PS helped them consider actual and possible future problems, needs and scenarios regarding all dimensions of PC ( 32 ). Surprisingly, this current study shows no effect of the use of the PS on the multidimensionality of the care plans.…”

Section: Discussionmentioning

confidence: 92%

Early identification of patients in need of palliative care in slovenian general practice

Klok

Engels

Veldhoven

et al. 2018

Slovenian Journal of Public Health

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BackgroundTo help general practitioners (GPs) in early identification of patients with palliative care (PC) needs, this pilot study aimed to determine the potential of the combined original surprise question (SQ1) (‘Would I be surprised if this patient died within the next 12 months?’) and the second surprise question (SQ2) (‘Would I be surprised if this patient was still alive after 12 months?’). We hypothesized that answering these SQs would trigger them to make a multidimensional care plan.Methods26 Slovenian GPs, randomized into 4 groups, were invited to write a care plan for each of the four patients described in case vignettes (2 oncologic, 1 organ failure and 1 frailty case). GPs in group 1 were only asked to write a care plan for each patient. GPs in group 2 answered SQ1 and GPs in groups 3 and 4 answered SQ1 and SQ2 before writing the care plan. The type and number of PC aspects mentioned in the respective care plans were quantified into a numeric RADboud ANTicipatory (RADIANT) score.ResultsMean RADIANT scores in groups 1-4 were 2.2, 3.6, 2.5 and 3.1, respectively. When comparing the different vignettes, vignette B (terminal oncologic patient) scored best (3.6). Mean RADIANT scores in groups 3 and 4 were slightly higher for GPs who would be surprised compared to GPs who would not be surprised if the patient was still alive in 12 months.ConclusionThe combined SQs were considered helpful in the early identification of patients in need of PC in Slovenian general practice.

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Section: Discussionmentioning

confidence: 92%

Early identification of patients in need of palliative care in slovenian general practice

Klok

Engels

Veldhoven

et al. 2018

Slovenian Journal of Public Health

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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Background Most French people (71%) would like to die at home, but only one out of four actually do. While the difficulties inherent in the practice of home-based palliative care are well described, few studies highlight the resources currently used by general practitioners (GPs) in real life. We have therefore sought to highlight the resources actually used by GPs providing home-based palliative care. Methods Twenty-one GPs of different ages and practice patterns agreed to participate to this qualitative study based upon semi-structured interviews. They were recruited according to a purposive sampling. Transcripts analysis was based upon General Inductive Analysis. Results The resources highlighted have been classified into two main categories according to whether they were internal or external to the GPs. The internal resources raised included the doctor’s practical experience and continuous medical education, personal history, work time organization and a tacit moral contract related to the referring GP’s position. External resources included resource personnel, regional assistance platforms and health facilities, legislation. Conclusion This study provides a simple list that is easy to share and pragmatic solutions for GPs and policymakers. Home-based palliative care practice can simultaneously be burdensome and yet a fulfilling, meaningful activity, depending on self-efficacy and professional exhaustion (burnout), perhaps to a greater extent than on medical knowledge. Home-based palliative care promotion is a matter of social responsibility. The availability of multidisciplinary teams such as regional assistance platforms and Hospitalization at Home is particularly important for the management of palliative care. Policymakers should consolidate these specific resources out of hospitals, in community settings where the patients wish to end their life.

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“…While this may explained by the typical illness trajectories [27] of these patients, late identification leaves little room for anticipatory action [28]. In addition, as these results reflect the poor performance of the SQ in the identification of noncancer patients reported in previous literature [17], it might be worthwhile to investigate the performance of other identification tools like SPICT [29] or RADPAC [30] in this context.…”

Section: Reflections On the Content Of The Meetings Of The Patzgroupsmentioning

confidence: 97%

Variation in the implementation of PaTz: a method to improve palliative care in general practice - a prospective observational study

et al. 2020

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Background: PaTz (palliative care at home) is a method to improve palliative care in the primary care setting in the Netherlands. PaTz has three basic principles: (1) local GPs and DNs meet at least six times per year to identify and discuss their patients with a life-threatening illness; (2) these meetings are supervised by a specialist palliative care professional; (3) groups use a palliative care register on which all identified patients are listed. Since the start in 2010, the number of PaTz-groups in the Netherlands has been growing consistently. Although the theory of all PaTz-groups is the same, the practical functioning of PaTz-groups may vary substantially, which may complicate further implementation of PaTz as well as interpretation of effect studies. This study aims to describe the variation in practice of PaTz-groups in the Netherlands.Method: In this prospective observational study, ten PaTz-groups logged and described the activities in their meetings as well as the registered and discussed patients and topics of discussions in registration forms for a 1 year follow-up period. In addition, non-participatory observations were performed in all participating groups. Meeting and patient characteristics were analysed using descriptive statistics. Conventional content analysis was performed in the analysis of topic discussions. Results: While the basic principles of PaTz are found in almost every PaTz-group, there is considerable variation in the practice and content of the meetings of different PaTz-groups. Most groups spend little time on other topics than their patients, although the number of patients discussed in a single meeting varies considerably, as well as the time spent on an individual patient. Most registered patients were diagnosed with cancer and patient discussions mainly concerned current affairs and rarely concerned future issues. Conclusion:The basic principles are the cornerstone of any PaTz-group. At the same time, the observed variation between PaTz-groups indicates that tailoring a PaTz-group to the needs of its participants is important and may enhance its sustainability. The flexibility of PaTz-groups may also provide opportunity to modify the content and tools used, and improve identification of palliative patients and advance care planning.

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Training general practitioners contributes to the identification of palliative patients and to multidimensional care provision: secondary outcomes of an RCT

Abstract: NTR2815; post results.

Cited by 26 publications

References 34 publications

Early identification of patients in need of palliative care in slovenian general practice

Early identification of patients in need of palliative care in slovenian general practice

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

Variation in the implementation of PaTz: a method to improve palliative care in general practice - a prospective observational study

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