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BMJ Support Palliat Care. 2018 Jul 25. pii: bmjspcare-2018-001549. doi: 10.1136/bmjspcare-2018-001549. [Epub ahead of print]

General practice palliative care: patient and carer expectations, advance care plans and place of death-a systematic review.

Author information

1
Medical School, The University of Western Australia, Perth, Western Australia, Australia.
2
School of Nursing & Midwifery, Monash University, Melbourne, Victoria, Australia.
3
Eastern Health, Melbourne, Victoria, Australia.
4
Sydney Nursing School, University of Sydney, Sydney, New South Wales, Australia.
5
General Practice Academic Unit, School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia.
6
Primary Care Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.
7
College of Health, Massey University, Auckland, New Zealand.
8
School of Nursing & Midwifery, Notre Dame University, Fremantle, Western Australia, Australia.
9
Centre for Nursing and Midwifery Research, St John of God Murdoch Hospital, Murdoch, Western Australia, Australia.
10
School of Nursing & Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia.
11
School of General Practice and Rural Medicine, University of Western Australia, Perth, Western Australia, Australia.
12
Primary Care Collaborative Cancer Clinical Trials Group, University of Melbourne, Melbourne, Victoria, Australia.
13
Victoria Comprehensive Cancer Centre Palliative Care Research Group, University of Melbourne, Melbourne, Victoria, Australia.
14
Département de médecine familiale et de médecined\'urgence, Universite Laval, Faculte de medecine, Québec City, Canada.
15
School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia.

Abstract

BACKGROUND:

With an increasing ageing population in most countries, the role of general practitioners (GPs) and general practice nurses (GPNs) in providing optimal end of life (EoL) care is increasingly important.

OBJECTIVE:

To explore: (1) patient and carer expectations of the role of GPs and GPNs at EoL; (2) GPs' and GPNs' contribution to advance care planning (ACP) and (3) if primary care involvement allows people to die in the place of preference.

METHOD:

Systematic literature review.

DATA SOURCES:

Papers from 2000 to 2017 were sought from Medline, Psychinfo, Embase, Joanna Briggs Institute and Cochrane databases.

RESULTS:

From 6209 journal articles, 51 papers were relevant. Patients and carers expect their GPs to be competent in all aspects of palliative care. They valued easy access to their GP, a multidisciplinary approach to care and well-coordinated and informed care. They also wanted their care team to communicate openly, honestly and empathically, particularly as the patient deteriorated. ACP and the involvement of GPs were important factors which contributed to patients being cared for and dying in their preferred place. There was no reference to GPNs in any paper identified.

CONCLUSIONS:

Patients and carers prefer a holistic approach to care. This review shows that GPs have an important role in ACP and that their involvement facilitates dying in the place of preference. Proactive identification of people approaching EoL is likely to improve all aspects of care, including planning and communicating about EoL. More work outlining the role of GPNs in end of life care is required.

KEYWORDS:

advance care planning; consumer expectations; general practice; place of death; primary palliative care

Conflict of interest statement

Competing interests: None declared.

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