Improving primary palliative care in Scotland: lessons from a mixed methods study

• Published in: BMC family practice 2015-12, Vol.16 (1), p.176-176, Article 176
• Main Authors: Mason, Bruce, Buckingham, Susan, Finucane, Anne, Hutchison, Peter, Kendall, Marilyn, McCutcheon, Hazel, Porteous, Lorna, Murray, Scott A
• Format: Article
• Language: English
• Subjects: Attitude of Health Personnel; Female; Humans; Male; Methods; Palliative Care - standards; Palliative Care - trends; Palliative treatment; Primary health care; Primary Health Care - standards; Primary Health Care - trends; Qualitative Research; Quality Improvement - organization & administration; Retrospective Studies; Scotland; State Medicine - standards; Terminal care
• ISSN: 1471-2296; 1471-2296
• DOI: 10.1186/s12875-015-0391-x

Since 2012, all GP practices across Scotland have been supported to take a systematic approach to end-of-life care, by helping them to identify more patients for palliative care through a Palliative Care Directed Enhanced Service (DES). We aimed to understand the impact of this initiative. Routine quantitative data from the 2012/13, and 2013/14 DES were collected from regional health boards, analysed and discussed. Qualitative data were collected from a sample of 2012/13 DES returns and analysed using Thematic Analysis. Data were received from 512 practices in nine Scottish Health boards for the 2012-13 DES and 638 practices in 11 Health boards for 2013-14. A sample of 90 of the returns for 2012-13 was selected for qualitative analysis. In 2012-13, 72 % of patients who died of cancer were listed on the palliative care register (PCR) before death while 27 % of patients who died as a result of non-malignant conditions were listed on the PCR. In 2013-14, cancer identification remained the same but identification of people dying with other long-term conditions had improved to 32.5 %. We identified several key issues needed to improve palliative care in the community. The need for training to identify patients with palliative care needs (particularly non-cancer); communication skills training; improvements in sharing information across the NHS; under-resource of and lack of coordination with district nurses; improvements in information technology; and tools for working with enlarged palliative care registers. The DES helped more patients with long-term conditions (LTC) receive generalist palliative care. Approaching generalist palliative care as anticipatory care could facilitate communication between GPs and patients/families and remove some barriers to early identification of palliative care needs. Improvement of information technology and use of identification tools like the SPICT™ may improve professionals' communication with each other and help may make identification and management of patients easier.