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Systematic review
General practice physicians’ and nurses’ self-reported multidisciplinary end-of-life care: a systematic review
  1. Hugh Senior1,
  2. Matthew Grant2,
  3. Joel J Rhee3,
  4. Michèle Aubin4,
  5. Peta McVey5,
  6. Claire Johnson6,7,
  7. Leanne Monterosso8,9,
  8. Harriet Nwachukwu10,
  9. Julia Fallon-Ferguson11,
  10. Patsy Yates12,
  11. Briony Williams11 and
  12. Geoffrey Mitchell10
  1. 1 College of Health, Massey University, Auckland, New Zealand
  2. 2 School of Medicine, Monash University, Melbourne, Victoria, Australia
  3. 3 School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
  4. 4 Département de Médecine Familiale et de Médecine D'urgence, Faculté de Médecine, Université Laval, Quebec City, Quebec, Canada
  5. 5 Susan Wakil School of Nursing and Midwifery, University of Sydney, Sydney, New South Wales, Australia
  6. 6 School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
  7. 7 Cancer and Palliative Care Research and Evaluation Unit, School of Surgery, The University of Western Australia, Crawley, Western Australia, Australia
  8. 8 School of Nursing and Midwifery, University of Notre Dame Fremantle, Fremantle, Western Australia, Australia
  9. 9 Centre for Nursing and Midwifery Research, St John of God Murdoch Hospital, Murdoch, Western Australia, Australia
  10. 10 Primary Care Clinical Unit, School of Clinical Medicine, University of Queensland, Brisbane, Queensland, Australia
  11. 11 General Practice, University of Western Australia, Perth, Western Australia, Australia
  12. 12 Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
  1. Correspondence to Professor Geoffrey Mitchell, Primary Care Clinical Unit, School of Clinical Medicine, University of Queensland, Herston 4006, Queensland, Australia; g.mitchell{at}uq.edu.au

Abstract

Background General practitioners (GPs) and general practice nurses (GPNs) face increasing demands to provide end-of-life care (EoLC) as the population ages. To enhance primary palliative care (PC), the care they provide needs to be understood to inform best practice models of care.

Objective To provide a comprehensive description of the self-reported role and performance of GPs and GPNs in (1) specific medical/nursing roles, (2) communication, (3) care co-ordination, (4) access and out-of-hours care, and (5) multidisciplinary care.

Method Systematic literature review. Data included papers (2000 to 2017) sought from Medline, Psychinfo, Embase, Joanna Briggs Institute and Cochrane databases.

Results From 6209 journal articles, 29 reviewed papers reported the GPs’ and GPNs’ role in EoLC or PC practice. GPs report a central role in symptom management, treatment withdrawal, non-malignant disease management and terminal sedation. Information provision included breaking bad news, prognosis and place of death. Psychosocial concerns were often addressed. Quality of communication depended on GP–patient relationships and GP skills. Challenges were unrealistic patient and family expectations, family conflict and lack of advance care planning. GPs often delayed end-of-life discussions until 3 months before death. Home visits were common, but less so for urban, female and part-time GPs. GPs co-ordinated care with secondary care, but in some cases parallel care occurred. Trust in, and availability of, the GP was critical for shared care. There was minimal reference to GPNs’ roles.

Conclusions GPs play a critical role in palliative care. More work is required on the role of GPNs, case finding and models to promote shared care, home visits and out-of-hours services.

  • palliative care
  • general practice
  • case management
  • patient care team
  • primary health care
  • systematic review

Data availability statement

Data are available on reasonable request.

https://doi.org/10.1136/bmjspcare-2019-001852

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    Data availability statement

    Data are available on reasonable request.

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    Footnotes

    • Contributors GM initiated this study, oversaw the design and conducted all parts of the review, and wrote the manuscript. JF-F and BW did the initial search and screen of ineligible papers. GM and HN searched data and screened ineligible papers from 2014 to 1017. HS wrote the draft of this paper. All other authors contributed to the design, the development of the separate research questions, read abstracts, determined eligibility, read full manuscripts, did quality assessments and data extraction, and approved the final manuscript.

    • Funding This paper was funded by Royal Australian College of General Practitioner/ HCF grant in 2013.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.