Better support needed for general practitioners to provide community palliative care

A blog post written by Dr. Jinfeng Ding

Palliative care aims to improve the quality of life of people with life-limiting illness and their families. In Australia, the majority of people spend most of their last year of life in a community setting, and often wish to stay at their own home with their loved ones until death. Our study found that patients most often died in a nursing home (35.7%), followed by hospice (23.9%), their own residence (21.6%) and hospital (18.8%). [1] Patients have substantial palliative care needs in their last stage of life, and frequently experience physical and psychological symptoms. These include reduced appetite (80.6%), fatigue (77.9%), breathing difficulties (58.7%), pain (58.1%), and psychological problems (44.9%).[2]

In Australian communities, General Practitioners (GPs) are often the first point of professional contact for health care needs. General Practitioners provide local and holistic care across a patient’s lifespan, including during the last stage of life. Many established GPs “grow old together” with their patients and develop long-term trusting relationships which are often beyond simple doctor-patient relationships. In most situations, therefore, GPs are amongst the most appropriate providers of palliative and end of life care for their patients, because they have greater knowledge of their patients’ care preferences and values than other care providers.

Our research found that GPs play a central role in meeting the palliative care needs of these patients, but also face multiple challenges. For more than 90% of reported patients, GPs played an important role in their last year of care. General practitioners supported the delivery of palliative care through home visits, consultations via telephone, family meetings, and care planning and team co-ordination. [2]

We identified a number of factors influencing delivery of good palliative care in general practice. These included strong doctor-patient relationships, availability of family support, and smooth communication and continuity of care between GPs and hospitals. Conversely, delivery of such care was hindered by factors such as limited palliative care training among GPs, inappropriate payment models, misconceptions over the goals of palliative care, and conflicts on implementing care plans among patients and their families. [3,4]

For around a third of patients, their experiences during the last year of care could had been improved if a comprehensive approach had been adopted to address the challenges facing GPs. Proposed measures to achieve this goal include a higher level of integration of specialist care into primary care, better payment models for GPs, greater information-sharing between GPs and hospitals through potentially using advanced information technology, additional palliative care training opportunities for GPs and additional external support from specialists, as well as a broader community-centered approach to supporting patients and their family. [3,4]

References:

1. Ding J, Johnson CE, Auret K, Ritson D, Masarei C, Chua D, et al. Comparison of end-of-life care for people living in home settings versus residential aged care facilities: A nationwide study among Australian general practitioners. Health Soc Care Community. 2022 Jan;30(1):91-101. doi: 10.1111/hsc.13375. Epub 2021 Apr 6.
2. Ding J, Johnson CE, Saunders C, Licqurish S, Chua D, Mitchell G, et al. Provision of end-of-life care in primary care: a survey of issues and outcomes in the Australian context. BMJ Open. 2022 Jan 19;12(1):e053535. doi: 10.1136/bmjopen-2021-053535.
3. Ding J, Saunders C, Cook A, Johnson CE. End-of-life care in rural general practice: how best to support commitment and meet challenges? BMC Palliat Care. 2019 Jun 25;18(1):51. doi: 10.1186/s12904-019-0435-4.
4. Ding J, Licqurish S, Cook A, Ritson D, Masarei C, Chua D, et al. Delivery and outcomes of end-of-life care in the Australian context: Experiences and reflections of general practitioners. Health Soc Care Community. 2022 Aug 2. doi: 10.1111/hsc.13931. Epub ahead of print.

Dr. Jinfeng Ding
Head of Xiangya Palliative Care Research Center
Central South University, Changsha, China