Palliative care consultations in primary care

Hoek, P.D. et al. BMJ Supportive & Palliative Care. Published online: 17 June 2016

NHS REFRESH

Background: Expert consultation supports general practitioners (GPs) in delivering adequate palliative homecare. Insight into consultation practices from a GP’s perspective is needed in order to shape consultation services to their wishes and needs.

Aim: To explore palliative care consultation practices from a GP’s perspective.

Design and setting: Cross-sectional web-based survey among all GPs (n=235) in the region of Nijmegen, the Netherlands.

Methods: Our questionnaire contained questions about the delivery of palliative care by GPs, their consultation practices and satisfaction with current services. Questions consisted mainly of 5-point Likert scales. We transformed these scales into numerical values to calculate mean scores. Linear mixed models for repeated measurements were used to study differences in scores.

Results: GPs most often consulted informal caregivers (mean score 3.6) or fellow GPs (mean score 3.3). Physical problems were discussed the most (mean score 3.5), while social and existential issues were discussed least (mean score 1.9 for both). In their choice of a particular consultation service, GPs considered the quality of the provided advice to be the most important factor. GPs were satisfied with current consultation services, with fellow GPs receiving the highest satisfaction scores (mean score 4.6). Finally, when recalling their last palliative patient, most GPs started requesting consultation during this patient’s last month of life.

Conclusions: Next to informal caregivers, GPs preferably seek advice from fellow GPs. Physical issues receive much attention during consultations; however, other vital aspects of palliative care seem to remain relatively neglected, such as social and existential issues and a proactive care approach.

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