Early identification of the end-of-life in primary care setting

Background: The Patient Self Determination Act was passed in 1991 and requires healthcare facilities to present patients with information regarding advanced directives. Since that time, there has been no improvement in the number of patients reported to have had such discussions. Numerous barriers to these discussions exist both on the patient and provider side. This study aims to identify barriers to end of life discussions among providers in the primary care setting. Methods: The study population included practicing primary care physicians in the OhioHealth system. They were administered an anonymous questionnaire addressing demographic information and questions specific to end of life discussions and what barriers exist. Results: A majority of primary care physicians reported engaging in end of life discussions with their patients. A majority of physicians cited lack of time as a barrier to having these discussions. There was a statistically significant age difference among primary care physicians who reported they have end of life discussions with their patients and among these physicians there was a statistically significant increase in their level of comfort having these discussions. Conclusion: Primary care physicians further into their career reported having end of life discussions more frequently and felt more comfortable doing so. Additionally, physicians cite lack of time as the most common barrier to holding end of life discussions.

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Nurses' Experience of the Early Identification of Depression in the Primary Care Setting of South Africa

Journal of Psychology in Africa ◽

10.1080/14330237.2010.10820374 ◽

2010 ◽

Vol 20 (2) ◽

pp. 259-264

Author(s):

Jeanette Maritz

Keyword(s):

South Africa ◽

Primary Care ◽

Early Identification ◽

Care Setting ◽

Primary Care Setting

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Spiritual care at the end of life in the primary care setting: experiences from spiritual caregivers - a mixed methods study

BMC Palliative Care ◽

10.1186/s12904-019-0484-8 ◽

2019 ◽

Vol 18 (1) ◽

Cited By ~ 2

Author(s):

Ian Koper ◽

H. Roeline W. Pasman ◽

Bart P. M. Schweitzer ◽

Annemieke Kuin ◽

Bregje D. Onwuteaka-Philipsen

Keyword(s):

Primary Care ◽

Palliative Care ◽

Mixed Methods ◽

Focus Group ◽

End Of Life ◽

Spiritual Care ◽

Care Setting ◽

Primary Care Setting ◽

Healthcare Providers ◽

Spiritual Issues

Abstract Background Spiritual care is an important aspect of palliative care. In the Netherlands, general practitioners and district nurses play a leading role in palliative care in the primary care setting. When they are unable to provide adequate spiritual care to their patient, they can refer to spiritual caregivers. This study aimed to provide an overview of the practice of spiritual caregivers in the primary care setting, and to investigate, from their own perspective, the reasons why spiritual caregivers are infrequently involved in palliative care and what is needed to improve this. Method Sequential mixed methods consisting of an online questionnaire with structured and open questions completed by 31 spiritual caregivers, followed by an online focus group with 9 spiritual caregivers, analysed through open coding. Results Spiritual caregivers provide care for existential, relational and religious issues, and the emotions related to these issues. Aspects of spiritual care in practice include helping patients find meaning, acceptance or reconciliation, paying attention to the spiritual issues of relatives of the patient, and helping them all to say farewell. Besides spiritual issues, spiritual caregivers also discuss topics related to medical care with patients and relatives, such as treatment wishes and options. Spiritual caregivers also mentioned barriers and facilitators for the provision of spiritual care, such as communication with other healthcare providers, having a relationship of trust and structural funding.. In the online focus group, local multidisciplinary meetings were suggested as ideal opportunities to familiarize other healthcare providers with spirituality and promote spiritual caregivers’ services. Also, structural funding for spiritual caregivers in the primary care setting should be organized. Conclusion Spiritual caregivers provide broad spiritual care at the end of life, and discuss many different topics beside spiritual issues with patients in the palliative phase, supporting them when making medical end-of-life decisions. Spiritual care in the primary care setting may be improved by better cooperation between spiritual caregiver and other healthcare providers, through improved education in spiritual care and better promotion of spiritual caregivers’ services.

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