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BMJ Support Palliat Care. 2019 Feb 12. pii: bmjspcare-2018-001653. doi: 10.1136/bmjspcare-2018-001653. [Epub ahead of print]

Primary palliative care research: opportunities and challenges.

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Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
Department of Primary Care and Public Health Sciences, King's College London, London, UK.
Clinical Research Network Eastern; Primary Care, Cambridge, UK.
Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn, UK.



Primary care has a central role in palliative and end of life care: 45.6% of deaths in England and Wales occur under the care of primary care teams at home or in care homes. The Community Care Pathways at the End of Life (CAPE) study investigated primary care provided for patients in the final 6 months of life. This paper highlights the opportunities and challenges associated with primary palliative care research in the UK, describing the methodological, ethical, logistical and gatekeeping challenges encountered in the CAPE study and how these were addressed.


Using a mixed-methods approach, quantitative data were extracted from the general practitioner (GP) and district nurse (DN) records of 400 recently deceased patients in 20 GP practices in the East of England. Focus groups were conducted with some GPs and DNs, and individual interviews held with bereaved carers and other GPs and DNs.


Considerable difficulties were encountered with ethical permissions, with GP, DN and bereaved carer recruitment and both quantitative and qualitative data collection. These were overcome with flexibility of approach, perseverance of the research team and strong user group support. This enabled completion of the study which generated a unique primary palliative care data set.


community nursing; general practice; home care; primary care; research methods; terminal care

Conflict of interest statement

Competing interests: None declared.

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