Primary care physicians’ educational needs and learning preferences in end of life care: A focus group study in the UK

Objectives: To describe physicians' end-of-life practices, perceptions regarding end-of-life care and characterize differences based upon physician specialty and demographic characteristics. To illuminate physicians' perceptions about differences among their African-American and Caucasian patients' preferences for end-of-life care.Design and methods: Twenty-four African-American and 16 Caucasian physicians (N= 40) participated in an in-person interview including 23 primary care physicians, 7 cardiologists, and 10 oncologists. Twenty-four practices were in urban areas and 16 were in rural counties.Results: Physicians perceived racial differences in preferences for end-of-life care between their Caucasian and African-American patients. Whereas oncologists and primary care physicians overwhelmingly reported having working relationships with hospice, only 57% of cardiologists reported having those contacts. African-American physicians were more likely than Caucasian physicians to perceive racial differences in their patients preferences for pain medication.Significance of results: Demographic factors such as race of physician and patient may impact the provider's perspective on end-of-life care including processes of care and communication with patients.

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US, Russian and Indian physician perspectives regarding end of life care

Russian Family Doctor ◽

10.17816/rfd41869 ◽

2020 ◽

Vol 24 (3) ◽

pp. 11-20

Author(s):

James G. Jackson ◽

Sheetal Moolambally Raj ◽

Yulia Matveeva ◽

Yinghui Xu ◽

Gerald J. Jogerst

Keyword(s):

Primary Care ◽

End Of Life ◽

End Of Life Care ◽

Primary Care Physicians ◽

Terminal Illness ◽

Life Care ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Chi Squared ◽

Dichotomous Variables

Aim. To compare US, Russian and Indian primary care physicians attitudes, comfort and experiences providing palliative care. Design. Cross sectional survey. Settings. Iowa, USA; Leningrad Oblast, Russia; Mangalore, India. Participants. Primary care physicians. Methods. Chi-squared testing for dichotomous variables and t-tests for mean scores. Results. 66 US, 81 Russian and 95 Indian physicians completed the survey. More US physicians preferred end of life care at home (83% v 56% Russian and 29% Indian) p 0.001 and Indian physicians preferring hospitals (36% v 0% US and 1% Russian) p 0.001. 94% percent of US physicians preferred patient make their own decisions, 57% of Russian sample preferred physicians as decision makers, and Indian physicians preferred family members to patients themselves (44%) p 0.001. Patient should be informed (US vs Russia vs India) of terminal illness Always (74% vs 31% vs 33%) p 0.001, If Asked (9% vs 64% vs 12%) p 0.001 or Physicians Judgement (15%, 5%, 54%) p 0.001. US physicians reported higher comfort rates with managing symptoms at the end of life. In the last 6 months US physicians were more satisfied with provided care Often or Always (63% vs 36% Russian v 21% Indian) p 0.001. Conclusions. US sample was more concerned with patient autonomy and had more comfort and satisfaction in providing end of life care compared to Russian and Indian samples.

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The Role of Primary Care Physicians in Providing End-of-Life Care

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909118808232 ◽

2018 ◽

Vol 36 (3) ◽

pp. 249-254 ◽

Cited By ~ 1

Author(s):

Jan Tse Liu ◽

Iris Kovar-Gough ◽

Nabila Farabi ◽

Frank Animikwam ◽

Sarah Beth Weers ◽

...

Keyword(s):

Primary Care ◽

End Of Life ◽

End Of Life Care ◽

Primary Care Physicians ◽

The United States ◽

Narrative Review ◽

Cochrane Library ◽

Life Care ◽

Number Of Patients ◽

Wide Range

Background: Primary care physicians (PCPs) frequently have long-term relationships with patients as well as their families. As such they are well positioned to care for their patients at the end of their lives. As the number of patients in need of end-of-life care continues to grow, it is critical to understand how PCPs can fulfill that need. The purpose of our study is to perform a narrative review of the literature and develop a theoretical model delineating the overarching roles played by PCPs in caring for patients at the end of life. Methods: For this narrative review, the authors searched Medline (PubMed), Embase, Cochrane Library, and Scopus up to March 22, 2017. Articles were not limited by geography. Results: Review of existing literature generally supports 4 broad categories as the primary roles for PCP involvement in end of life: pain and symptom management; information management, including transmitting and clarifying information, setting care priorities, and assisting patients with treatment decisions; coordinating care and collaborating with other providers; and addressing patients’ social, emotional, and spiritual needs. Conclusions: Based on the results of this review, PCPs provide a wide range of services to patients at the end of life. Promoting the provision of the full scope of services by PCPs will help ensure improved continuity of care while providing the highest quality of care for patients, both in the United States and around the world.

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NUrsing Homes End of Life care Program (NUHELP): developing a complex intervention

BMC Palliative Care ◽

10.1186/s12904-021-00788-1 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Emilio Mota-Romero ◽

Ana Alejandra Esteban-Burgos ◽

Daniel Puente-Fernández ◽

María Paz García-Caro ◽

Cesar Hueso-Montoro ◽

...

Keyword(s):

Primary Care ◽

Palliative Care ◽

Nursing Home ◽

Nursing Homes ◽

Focus Group ◽

End Of Life ◽

Complex Intervention ◽

End Of Life Care ◽

Care Program ◽

Life Care

Abstract Background Nursing homes are likely to become increasingly important as end-of-life care facilities. Previous studies indicate that individuals residing in these facilities have a high prevalence of end-of-life symptoms and a significant need for palliative care. The aim of this study was to develop an end-of-life care program for nursing homes in Spain based on previous models yet adapted to the specific context and the needs of staff in nursing homes in the country. Methods A descriptive study of a complex intervention procedure was developed. The study consisted of three phases. The first phase was a prospective study assessing self-efficacy in palliative care (using the SEPC scale) and attitudes towards end-of-life care (using the FATCOD-B scale) among nursing home staff before and after the completion of a basic palliative care training program. In the second phase, objectives were selected using the Delphi consensus technique, where nursing home and primary care professionals assessed the relevance, feasibility, and level of attainment of 42 quality standards. In phase 3, interventions were selected for these objectives through two focus group sessions involving nursing home, primary care, and palliative care professionals. Results As a result of the training, an improvement in self-efficacy and attitudes towards end-of-life care was observed. In phase 2, 14 standards were selected and grouped into 5 objectives: to conduct a comprehensive assessment and develop a personalized care plan adapted to the palliative needs detected; to provide information in a clear and accessible way; to request and record advance care directives; to provide early care with respect to loss and grief; to refer patients to a specialized palliative care unit if appropriate, depending on the complexity of the palliative care required. Based on these objectives, the participants in the focus group sessions designed the 22 interventions that make up the program. Conclusions The objectives and interventions of the NUHELP program constitute an end-of-life care program which can be implemented in nursing homes to improve the quality of end-of-life care in these facilities by modifying their clinical practice, organization, and relationship with the health system as well as serving as an example of an effective health intervention program.

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Health Care Professionals’ Understandings of Cross-Cultural Interaction in End-of-Life Care: A Focus Group Study

PLoS ONE ◽

10.1371/journal.pone.0165452 ◽

2016 ◽

Vol 11 (11) ◽

pp. e0165452 ◽

Cited By ~ 5

Author(s):

Anna Milberg ◽

Sandra Torres ◽

Pernilla Ågård

Keyword(s):

Health Care ◽

Focus Group ◽

End Of Life ◽

Health Care Professionals ◽

End Of Life Care ◽

Cross Cultural ◽

Life Care ◽

Cultural Interaction ◽

Focus Group Study

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Palliative care for non-cancer conditions in primary care: a time trend analysis in the UK (2009–2014)

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2019-001833 ◽

2020 ◽

pp. bmjspcare-2019-001833 ◽

Cited By ~ 2

Author(s):

Amy Gadoud ◽

Eleanor Kane ◽

Steven Edward Oliver ◽

Miriam J Johnson ◽

Una Macleod ◽

...

Keyword(s):

Heart Failure ◽

Primary Care ◽

Palliative Care ◽

End Of Life ◽

End Of Life Care ◽

Life Care ◽

Primary Care Record ◽

Care Approach ◽

Hospital Deaths ◽

The Uk

ObjectivesWhile guidelines recommend palliative care in non-cancer conditions, this has not been widely implemented. We examined whether the recording of a palliative care approach and the numbers of hospital deaths for deceased patients with heart failure, dementia, chronic obstructive pulmonary disease (COPD) and cancer have changed since the UK End-of-Life Care Strategy was introduced.MethodsWe conducted sequential cross-sectional studies of decedents within the UK’s Clinical Practice Research Datalink and Hospital Episode Statistics. All adults with a primary care record of COPD (n=5426), dementia (n=7339), heart failure (n=6409) or cancer (n=18 668) who died during three 1 year periods (April 2009 to March 2014) were included. Evidence of a palliative care approach was identified from primary care records, and death in hospital from secondary care data.ResultsFrom 2009 to 2014, proportions with a primary care record of palliative care increased for COPD from 13.6% to 21.2%; dementia from 20.9% to 40.7%; and heart failure from 12.6% to 21.2%; but remained substantially lower than for cancer (57.6% to 61.9%). Median days before death of recording improved for COPD (145 to 224) and dementia (44 to 209); but not for heart failure (168.5 to 153) and cancer (123 to 114). Trends in hospital deaths were not consistently downward, although the proportions of patients dying in hospital were lower in the last period compared with the first.ConclusionsRecording of a palliative care approach for non-cancer conditions has increased since the introduction of the UK End-of-Life Care Strategy, but remains inadequate.

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The Safer Prescription of Opioids Tool (SPOT) — a novel clinical decision support digital health platform for opioid conversion in palliative and end-of-life care: a single centre pilot study

British Journal of General Practice ◽

10.3399/bjgp19x703265 ◽

2019 ◽

Vol 69 (suppl 1) ◽

pp. bjgp19X703265

Author(s):

Roger Flint ◽

Scott Jamieson ◽

Dean Buchanan ◽

S Botros ◽

Joanna Forbes ◽

...

Keyword(s):

Primary Care ◽

Decision Support ◽

Pilot Study ◽

Focus Group ◽

End Of Life ◽

End Of Life Care ◽

Life Care ◽

Single Centre ◽

Out Of Hours ◽

Opioid Dose

BackgroundOpioid conversion is complex and currently performed manually using tables of approximate equivalence, often in high pressure clinical situations. Apps that offer opioid dose conversion are available but there are concerns about their accuracy, reliability, and clinical validation.AimThe study evaluated a novel opioid dose conversion app, The Safer Prescription of Opioids Tool (SPOT), as a clinician decision support (CDS) platform. The secondary objective was to use SPOT to describe patterns of opioid dose conversion in palliative and end-of-life care.MethodThis prospective clinical utility single-centre pilot study followed a mixed methods design. Prescribers completed an initial survey exploring their current opioid prescribing practice. Thereafter prescribers used SPOT for opioid dosage conversions in parallel to their usual clinical practice. Lastly, prescribers evaluated SPOT through a survey and focus group. SPOT was evaluated using clinical data across primary, secondary and tertiary care in palliative care and end of life care settings at a Scottish Health Board in both out-of-hours and in-hours.ResultsSPOT correctly matched the Gold Standard result in 258 of 268 (96.3%) calculations. Users had a statistically significant increase in confidence in prescribing opioids after using SPOT. A majority (62%) of conversions were for cancer pain. Focus group feedback highlighted perceived benefits in Quality Improvement and Safety when using SPOT.ConclusionSPOT is a safe, reliable and validated CDS that has significant potential to reduce harms from opioid dosing errors, particularly in primary care, including rural primary care, and the out-of-hours setting.

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Community end-of-life care during the COVID-19 pandemic: Initial findings of a UK primary care survey

10.1101/2021.02.15.21251756 ◽

2021 ◽

Author(s):

Sarah Mitchell ◽

Phillip Oliver ◽

Clare Gardiner ◽

Helen Chapman ◽

Dena Khan ◽

...

Keyword(s):

Primary Care ◽

Palliative Care ◽

General Practice ◽

End Of Life ◽

General Practitioners ◽

End Of Life Care ◽

Life Care ◽

Face To Face ◽

The Uk ◽

Remote Consultations

AbstractBackgroundThousands of people in the UK have required end-of-life care in the community during the COVID-19 pandemic. Primary healthcare teams (general practice and community nursing services) have provided the majority of this care, alongside specialist colleagues. There is a need to learn from this experience in order to inform future service delivery and planning.AimTo understand the views of general practitioners and community nurses providing end-of-life care during the first wave of the COVID-19 pandemic.Design and SettingA web-based, UK-wide questionnaire survey circulated via professional general practice and community nursing networks during September and October 2020.MethodResponses were analysed using descriptive statistics and an inductive thematic analysis.ResultsValid responses were received from 559 individuals (387 community nurses, 156 General Practitioners (GPs) and 16 unspecified role), from all regions of the UK. The majority reported increased involvement in providing community end-of-life care. Contrasting and potentially conflicting roles emerged between GPs and community nurses. There was increased use of remote consultations, particularly by GPs. Community nurses took greater responsibility in most aspects of end-of-life care practice, particularly face-to-face care, but reported feeling isolated. For some GPs and community nurses, there has been considerable emotional distress.ConclusionPrimary healthcare services are playing a critical role in meeting increased need for end-of-life care in the community during the COVID-19 pandemic. They have adapted rapidly, but the significant emotional impact, especially for community nurses, needs addressing alongside rebuilding trusting and supportive team dynamics.How this fits in (4 sentences)This study provides insights into experiences of delivering end-of-life care in the community during the first wave of the COVID-19 pandemic from the perspectives of UK general practitioners (GPs) and community nurses.Services have changed and adapted rapidly to meet increased need in terms of both volume and complexity, with community nurses taking greater responsibility for most areas of palliative care clinical practice, and GPs undertaking more care planning conversations.While GPs and specialist palliative care services conducted more remote consultations, community nurses carried out face-to-face end-of-life care and reported a feeling of isolation.As the pandemic progresses, and the increased need for end-of-life care in the community persists, more effective service models and multi-disciplinary teamwork in primary care are urgently needed.

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