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Facilitators and barriers to general practitioner and general practice nurse participation in end-of-life care: systematic review
  1. Joel J Rhee1,2,
  2. Matthew Grant3,
  3. Hugh Senior4,
  4. Leanne Monterosso5,6,
  5. Peta McVey7,
  6. Claire Johnson8,9,
  7. Michèle Aubin10,
  8. Harriet Nwachukwu11,
  9. Claire Bailey12,
  10. Julia Fallon-Ferguson13,14,
  11. Patsy Yates15,
  12. Briony Williams13,14 and
  13. Geoffrey Mitchell11
  1. 1 School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
  2. 2 School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
  3. 3 School of Medicine, Monash University, Clayton, Victoria, Australia
  4. 4 College of Health Sciences, Massey University—Albany Campus, Auckland, New Zealand
  5. 5 School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
  6. 6 School of Nursing, University of Notre Dame, Fremantly, Western Australia, Australia
  7. 7 Susan Wakil School of Nursing, University of Sydney, Sydney, New South Wales, Australia
  8. 8 Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
  9. 9 Cancer and Palliative Care Research and Evaluation Unit, School of Surgery, The University of Western Australia, Perth, Western Australia, Australia
  10. 10 Département de médecine familiale et de médecine d'urgence, Laval University Faculty of Medicine, Quebec City, Quebec, Canada
  11. 11 Primary Care Clinical Unit, The University of Queensland Faculty of Medicine, Herston, Queensland, Australia
  12. 12 School of Medicine, University of Notre Dame, Sydney, New South Wales, Australia
  13. 13 General Practice, The University of Western Australia, Perth, Western Australia, Australia
  14. 14 Primary Care Cancer Clinical Trials Collaborative, University of Melbourne, Melbourne, Victoria, Australia
  15. 15 Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
  1. Correspondence to Professor Geoffrey Mitchell, Primary Care Clinical Unit, The University of Queensland Faculty of Medicine, Herston QLD 4006, Australia; g.mitchell{at}


Background General practitioners (GPs) and general practice nurses (GPNs) face increasing demands to provide palliative care (PC) or end-of-life care (EoLC) as the population ages. To enhance primary EoLC, the facilitators and barriers to their provision need to be understood.

Objective To provide a comprehensive description of the facilitators and barriers to GP and GPN provision of PC or EoLC.

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

Results From 6209 journal articles, 62 reviewed papers reported the GP’s and GPN’s role in EoLC or PC practice. Six themes emerged: patient factors; personal GP factors; general practice factors; relational factors; co-ordination of care; availability of services. Four specific settings were identified: aged care facilities, out-of-hours care and resource-constrained settings (rural, and low-income and middle-income countries). Most GPs provide EoLC to some extent, with greater professional experience leading to increased comfort in performing this form of care. The organisation of primary care at practice, local and national level impose numerous structural barriers that impede more significant involvement. There are potential gaps in service provision where GPNs may provide significant input, but there is a paucity of studies describing GPN routine involvement in EoLC.

Conclusions While primary care practitioners have a natural role to play in EoLC, significant barriers exist to improved GP and GPN involvement in PC. More work is required on the role of GPNs.

  • communication
  • chronic conditions
  • home care
  • education and training
  • service evaluation
  • supportive care

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  • X @GeoffM_GP

  • Correction notice This article has been updated since it was first published. The article type has been changed to Systematic review.

  • Collaborators May-Lill Johanson, Chalachew Alemayehu.

  • Contributors GM initiated this study, oversaw the design and conducted all parts of the review, and extensively edited 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. JJR wrote the initial draft of the manuscript. All other authors (MG, HS, LM, PM, CJ, MA, CB, PY) 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.