Improving primary palliative care – a Delphi consensus study on measures for general practice in Germany

Abstract Background The majority of severely ill and dying people in Germany can be administered primary palliative care (PPC) by general practitioners (GP). However, the current provision of PPC does not match the needs of the population. Although several public health strategies aim at strengthening the role of GPs in PPC provision, it remains challenging for GP teams to integrate PPC into their daily routines. Aim A Delphi study with GPs was conducted to achieve consensus on specific measures for improving the integration of PPC into everyday GP practice. Methods The study is part of the junior research project “Primary Palliative Care in General Practice” (ALLPRAX). After having developed, tested and evaluated 26 practical measures for GP practices to improve their PPC, a Delphi consensus study among GPs took place. In 2020, 569 GPs were asked to rate the relevance and feasibility of the measures on a 4-point Likert scale via an anonymous online questionnaire. Consensus was defined as a sum percentage of ‘strongly agree’ and ‘somewhat agree’ responses ≥75% after two rounds. Between these rounds, measures that were not consented in the first round were adapted in light of respondents’ free text comments and suggestions. Results The response rate was 11.3% in round 1 (n = 64) and 53.1% in round 2 (n = 34). From the initial n = 26 measures, n = 20 measures achieved consensus and were included in the final intervention package. The consented measures pertained to four main topics: advance care planning with patients, consulting and informing patients and family caregivers, GP office organisation and continuing education. N = 6 measures did not achieve consensus, predominantly due to time and workload constraints. Conclusion The consented measures provide valuable support to improve the provision of PPC by GPs. They can be used freely and flexibly, according to the needs of individual GP teams, and are thus suitable for implementation nationwide. Trial registration The study was registered in the German Clinical Trials Register (Registration N° DRKS00011821; 4 December 2017; https://apps.who.int/trialsearch/) and the German Register of Health Care Research (Registration N° VfD_ALLPRAX_16_003817; 30 March 2017).

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Factors influencing career intentions on completion of general practice vocational training in England: a cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2017-017143 ◽

2017 ◽

Vol 7 (8) ◽

pp. e017143 ◽

Cited By ~ 12

Author(s):

Jeremy Dale ◽

Rachel Russell ◽

Emma Scott ◽

Katherine Owen

Keyword(s):

General Practice ◽

Vocational Training ◽

Local Level ◽

Sociodemographic Factors ◽

Free Text ◽

Online Questionnaire ◽

Career Intentions ◽

Cross Sectional ◽

Career Plans ◽

Modifiable Factors

ObjectivesGeneral practice is experiencing a growing crisis with the numbers of doctors who are training and then entering the profession in the UK failing to keep pace with workforce needs. This study investigated the immediate to medium term career intentions of those who are about to become general practitioners (GPs) and the factors that are influencing career plans.DesignOnline questionnaire survey, with quantitative answers analysed using descriptive statistics and free text data analysed using a thematic framework approach.Setting and participantsDoctors approaching the end of 3-year GP vocational training in the West Midlands, England.Results178 (57.2%) doctors completed the survey. Most participants planned to work as salaried GPs or locums rather than entering a general practice partnership for at least the first 5 years post-completion of training; others failed to express a career plan or planned to leave general practice completely or work overseas. Many were interested in developing portfolio careers.The quality of general practice experience across undergraduate, foundation and vocational training were reported as influencing personal career plans, and in particular perceptions about workload pressure and morale within the training practices in which they had been placed. Experience of a poor work–life balance as a trainee had a negative effect on career intentions, as did negative perceptions about how general practice is portrayed by politicians and the media.ConclusionThis study describes a number of potentially modifiable factors related to training programmes that are detrimentally influencing the career plans of newly trained GPs. In addition, there are sociodemographic factors, such as age, gender and having children, which are also influencing career plans and so need to be accommodated. With ever-increasing workload in general practice, there is an urgent need to understand and where possible address these issues at national and local level.

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Personalising care of adults with asthma from Asia: a modified e-Delphi consensus study to inform management tailored to attitude and control profiles

npj Primary Care Respiratory Medicine ◽

10.1038/npjpcrm.2016.89 ◽

2017 ◽

Vol 27 (1) ◽

Cited By ~ 2

Author(s):

Alison Chisholm ◽

◽

David B Price ◽

Hilary Pinnock ◽

Tan Tze Lee ◽

...

Keyword(s):

Social Scientist ◽

Free Text ◽

Delphi Consensus ◽

Online Questionnaire ◽

Consensus Recommendations ◽

International Panel ◽

Delphi Round ◽

Asthma Patients ◽

Management Approaches ◽

And Control

Abstract REALISE Asia—an online questionnaire-based study of Asian asthma patients—identified five patient clusters defined in terms of their control status and attitude towards their asthma (categorised as: ‘Well-adjusted and at least partly controlled’; ‘In denial about symptoms’; ‘Tolerating with poor control’; ‘Adrift and poorly controlled’; ‘Worried with multiple symptoms’). We developed consensus recommendations for tailoring management of these attitudinal–control clusters. An expert panel undertook a three-round electronic Delphi (e-Delphi): Round 1: panellists received descriptions of the attitudinal–control clusters and provided free text recommendations for their assessment and management. Round 2: panellists prioritised Round 1 recommendations and met (or joined a teleconference) to consolidate the recommendations. Round 3: panellists voted and prioritised the remaining recommendations. Consensus was defined as Round 3 recommendations endorsed by >50% of panellists. Highest priority recommendations were those receiving the highest score. The multidisciplinary panellists (9 clinicians, 1 pharmacist and 1 health social scientist; 7 from Asia) identified consensus recommendations for all clusters. Recommended pharmacological (e.g., step-up/down; self-management; simplified regimen) and non-pharmacological approaches (e.g., trigger management, education, social support; inhaler technique) varied substantially according to each cluster’s attitude to asthma and associated psychosocial drivers of behaviour. The attitudinal–control clusters defined by REALISE Asia resonated with the international panel. Consensus was reached on appropriate tailored management approaches for all clusters. Summarised and incorporated into a structured management pathway, these recommendations could facilitate personalised care. Generalisability of these patient clusters should be assessed in other socio-economic, cultural and literacy groups and nationalities in Asia.

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CATALISE: a multinational and multidisciplinary Delphi consensus study. Identifying language impairments in children

10.7287/peerj.preprints.1986v1 ◽

2016 ◽

Cited By ~ 2

Author(s):

Dorothy V Bishop ◽

Margaret J Snowling ◽

Paul A Thompson ◽

Trisha Greenhalgh ◽

Keyword(s):

Evidence Base ◽

Language Impairments ◽

Free Text ◽

Language Therapy ◽

Delphi Consensus ◽

Relevant Evidence ◽

Specialist Services ◽

Starting Point ◽

Strongly Agree ◽

Education Psychology

Delayed or impaired language development is a common developmental concern, yet there is little agreement about the criteria used to identify and classify language impairments in children. Children's language difficulties are at the interface between education, medicine and the allied professions, who may all adopt different approaches to conceptualising them. Our goal in this study was to use an online Delphi technique to see whether it was possible to achieve consensus among professionals on appropriate criteria for identifying children who might benefit from specialist services. We recruited a panel of 59 experts representing ten disciplines (including education, psychology, speech-language therapy/pathology, paediatrics and child psychiatry) from English-speaking countries (Australia, Canada, Ireland, New Zealand, United Kingdom and USA). The starting point for round 1 was a set of 46 statements based on articles and commentaries in a special issue of a journal focusing on this topic. Panel members rated each statement for both relevance and validity on a seven-point scale, and added free text comments. These responses were synthesised by the first two authors, who then removed, combined or modified items with a view to improving consensus. The resulting set of statements was returned to the panel for a second evaluation (round 2). Consensus (percentage reporting 'agree' or 'strongly agree') was at least 80 per cent for 24 of 27 round 2 statements, though many respondents qualified their response with written comments. These were again synthesised by the first two authors. The resulting consensus statement is reported here, with additional summary of relevant evidence, and a concluding commentary on residual disagreements and gaps in the evidence base.

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SP2.1.11Real-world use of workplace-based assessments in surgical training: a UK nationwide exploration of trainee perspectives and consensus recommendations from the Association of Surgeons in Training

British Journal of Surgery ◽

10.1093/bjs/znab361.031 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

A.J. Beamish ◽

M Rabie ◽

M.J. Johnston ◽

D Nally ◽

G Humm ◽

...

Keyword(s):

Surgical Training ◽

Annual Review ◽

Free Text ◽

Delphi Consensus ◽

Online Questionnaire ◽

Consensus Recommendations ◽

Modified Delphi ◽

Surgical Trainees ◽

Training Standards ◽

The Will

Abstract Background The utility of Workplace-Based Assessments (WBAs) in surgical training depends on the way they are completed. This study aims to ascertain the real-world usage of WBAs, as perceived by UK surgical trainees. Methods An anonymous national online questionnaire was conducted via the Association of Surgeons in Training (ASiT). The evaluation employed mixed methods to interpret quantitative and qualitative data. Suggestions for improvement were identified from free-text comments and considered through a formal two-round modified Delphi consensus process by ASiT council members. Results Analysis included 906 complete responses from all surgical specialities across all training levels. WBA use was perceived to deviate markedly from the Joint Committee on Surgical Training standards with significantly identified misuse across all surgical specialities. Inaccurate completion was acknowledged by 89.6% of respondents, and some trainers appear complicit with 40.9% of respondents aware of 'unobserved sign-off', and 33.6% aware of 'password disclosure' by trainers. Most trainees felt the Annual Review of Competency Progression (ARCP) respected WBA quantity above quality (55.4%), and a third felt pressure to overstate the number completed (32.0%). Main reasons for misuse were time restraints, lack of engagement and the will to achieve career progression targets. Conclusions UK surgical trainees perceive a significant deviation from WBAs standards due to multiple factors. The frequency and nature of misuse are worrying and undermines the existing evidence for the WBAs role in training. We present consensus recommendations from ASiT for the improvement of WBA use in UK surgical training.

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CATALISE: a multinational and multidisciplinary Delphi consensus study. Identifying language impairments in children

10.7287/peerj.preprints.1986 ◽

2016 ◽

Author(s):

Dorothy V Bishop ◽

Margaret J Snowling ◽

Paul A Thompson ◽

Trisha Greenhalgh ◽

Keyword(s):

Evidence Base ◽

Language Impairments ◽

Free Text ◽

Language Therapy ◽

Delphi Consensus ◽

Relevant Evidence ◽

Specialist Services ◽

Starting Point ◽

Strongly Agree ◽

Education Psychology

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Palliative Care in General Practice, a contradiction in terms? A Systematic Review

10.26226/morressier.5c76c8b8e2ea5a7237611eb3 ◽

2019 ◽

Author(s):

Roberto Forero

Keyword(s):

Systematic Review ◽

Palliative Care ◽

General Practice

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Awareness of limited joint mobility in type 2 diabetes in general practice in the Netherlands: an online questionnaire survey

BMC Family Practice ◽

10.1186/s12875-019-0987-7 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 3

Author(s):

Jasmien Jaeken ◽

Geert-Jan Dinant ◽

Ramon P. G. Ottenheijm

Keyword(s):

Type 2 Diabetes ◽

General Practice ◽

The Netherlands ◽

Questionnaire Survey ◽

Joint Mobility ◽

Online Questionnaire ◽

Limited Joint Mobility

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The development of a faecal incontinence core outcome set: an international Delphi study protocol

International Journal of Colorectal Disease ◽

10.1007/s00384-021-03865-2 ◽

2021 ◽

Vol 36 (3) ◽

pp. 617-622

Author(s):

Sadé Assmann ◽

Daniel Keszthelyi ◽

Jos Kleijnen ◽

Merel Kimman ◽

Foteini Anastasiou ◽

...

Keyword(s):

Systematic Review ◽

Study Protocol ◽

Faecal Incontinence ◽

Delphi Study ◽

Evidence Synthesis ◽

Core Outcome Set ◽

Core Outcome ◽

Delphi Consensus ◽

Link Type ◽

Outcome Set

Abstract Purpose Faecal incontinence (FI) is estimated to affect around 7.7% of people. There is a lack of uniformity in outcome definitions, measurement and reporting in FI studies. Until now, there is no general consensus on which outcomes should be assessed and reported in FI research. This complicates comparison between studies and evidence synthesis, potentially leading to recommendations not evidence-based enough to guide physicians in selecting an FI therapy. A solution for this lack of uniformity in reporting of outcomes is the development of a Core Outcome Set (COS) for FI. This paper describes the protocol for the development of a European COS for FI. Methods Patient interviews and a systematic review of the literature will be performed to identify patient-, physician- and researcher-oriented outcomes. The outcomes will be categorised using the COMET taxonomy and put forward to a group of patients, physicians (i.e. colorectal surgeons, gastroenterologists and general practitioners) and researchers in a Delphi consensus exercise. This exercise will consist of up to three web-based rounds in which participants will prioritise and condense the list of outcomes, which is expected to result in consensus. A consensus meeting with participants from all stakeholder groups will take place to reach a final agreement on the COS. Discussion This study protocol describes the development of a European COS to improve reliability and consistency of outcome reporting in FI studies, thereby improving evidence synthesis and patient care. Trial registration This project has been registered in the COMET database on the 1st of April 2020, available at http://www.comet-initiative.org/Studies/Details/1554. The systematic review has been registered on the PROSPERO database on the 31st of August 2020, available at https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=202020&VersionID=1381336.

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National Competencies for Registered Nurses in Primary Care: A Delphi Study

Western Journal of Nursing Research ◽

10.1177/0193945920935590 ◽

2020 ◽

Vol 42 (12) ◽

pp. 1078-1087

Author(s):

Julia Lukewich ◽

Michelle Allard ◽

Lisa Ashley ◽

Kris Aubrey-Bassler ◽

Denise Bryant-Lukosius ◽

...

Keyword(s):

Primary Care ◽

Registered Nurses ◽

Delphi Study ◽

Delphi Consensus ◽

Care Experience ◽

Role Integration ◽

Partnership Quality ◽

Research Leadership ◽

Team Functioning ◽

Final Round

A Delphi (consensus) process was used to obtain national agreement on competencies for registered nurses (RNs) in primary care. A draft of competencies was developed by key informants. Following this, nurses with primary care experience/expertise completed a Delphi survey to rate the importance of competency statements on a six-point Likert scale. Statements not reaching consensus (agreement ≥80%) were modified and included in a second (final) round. The first survey was completed by 63% ( n = 86/137) of participants and 84% ( n = 72/86) of these participants completed the second survey. Most statements ( n = 45) achieved agreement after the first survey; one statement was dropped and two were combined following the second round. The final list of competencies consists of 47 statements across six domains (professionalism; clinical practice; communication; collaboration and partnership; quality assurance, evaluation, and research; leadership). National competencies will help strengthen the RN workforce within primary care, improve team functioning, and support role integration/optimization.

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Mapping end-of-life and anticipatory medications in palliative care patients using a longitudinal general practice database

Palliative & Supportive Care ◽

10.1017/s1478951521000092 ◽

2021 ◽

pp. 1-7

Author(s):

H. Khalil ◽

M. Garett ◽

A. Byrne ◽

P. Poon ◽

K. Gardner ◽

...

Keyword(s):

Health Care ◽

Palliative Care ◽

General Practice ◽

End Of Life ◽

Nurse Practitioners ◽

Hospital Admissions ◽

Population Level ◽

Screening Tools ◽

Care Needs ◽

Stakeholder Consultation

Abstract Objective End-of-life and anticipatory medications (AMs) have been widely used in various health care settings for people approaching end-of-life. Lack of access to medications at times of need may result in unnecessary hospital admissions and increased patient and family distress in managing palliative care at home. The study aimed to map the use of end-of-life and AM in a cohort of palliative care patients through the use of the Population Level Analysis and Reporting Data Space and to discuss the results through stakeholder consultation of the relevant organizations. Methods A retrospective observational cohort study of 799 palliative care patients in 25 Australian general practice health records with a palliative care referral was undertaken over a period of 10 years. This was followed by stakeholders’ consultation with palliative care nurse practitioners and general practitioners who have palliative care patients. Results End-of-life and AM prescribing have been increasing over the recent years. Only a small percentage (13.5%) of palliative care patients received medications through general practice. Stakeholders’ consultation on AM prescribing showed that there is confusion about identifying patients needing medications for end-of-life and mixed knowledge about palliative care referral pathways. Significance of results Improved knowledge and information around referral pathways enabling access to palliative care services for general practice patients and their caregivers are needed. Similarly, the increased utility of screening tools to identify patients with palliative care needs may be useful for health care practitioners to ensure timely care is provided.

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