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General practice nurses and physicians and end of life: a systematic review of models of care
  1. Geoffrey Mitchell1,
  2. Michèle Aubin2,
  3. Hugh Senior1,3,
  4. Claire Johnson4,5,
  5. Julia Fallon-Ferguson6,7,
  6. Briony Williams6,7,
  7. Leanne Monterosso8,9,
  8. Joel J Rhee10,
  9. Peta McVey11,
  10. Matthew Grant12,
  11. Harriet Nwachukwu1 and
  12. Patsy Yates13
  1. 1 Primary Care Clinical Unit, University of Queensland, Herston, Queensland, Australia
  2. 2 Département de médecine familiale et de médecine d'urgence, Faculté de médecine, Université Laval, Quebec City, Quebec, Canada
  3. 3 College of Health, Massey University, Auckland, New Zealand
  4. 4 Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
  5. 5 Medical School, The University of Western Australia, Crawley, Western Australia, Australia
  6. 6 Primary Care Collaborative Cancer Clinical Trials Group, The University of Melbourne, Melbourne, Victoria, Australia
  7. 7 General Practice, University of Western Australia, Perth, Western Australia, Australia
  8. 8 School of Nursing, Notre Dame University, Perth, Western Australia, Australia
  9. 9 School of Nursing, Edith Cowan University, Joondalup, Western Australia, Australia
  10. 10 General Practice Unit, University of Wollongong, Wollongong, New South Wales, Australia
  11. 11 Susan Wakil School of Nursing, University of Sydney, Sydney, New South Wales, Australia
  12. 12 School of Medicine, Monash University, Melbourne, Victoria, Australia
  13. 13 Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
  1. Correspondence to Professor Geoffrey Mitchell, Primary Care Clinical Unit, University of Queensland, 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. In order to maximise the impact of GPs and GPNs, the impact of different models of care that have been developed to support their practice of EoLC needs to be understood.

Objective To examine published models of EoLC that incorporate or support GP and GPN practice, and their impact on patients, families and the health system.

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, 13 papers reported models of care supporting the GP and GPN’s role in EoLC or PC practice. Services and guidelines for clinical issues have mixed impact on improving symptoms, but improved adherence to clinical guidelines. National Frameworks facilitated patients being able to die in their preferred place. A single specialist PC-GP case conference reduced hospitalisations, better maintained functional capacity and improved quality of life parameters in both patients with cancer and without cancer. No studies examined models of care aimed at supporting GPNs.

Conclusions Primary care practitioners have a natural role to play in EoLC, and most patient and health system outcomes are substantially improved with their involvement. Successful integrative models need to be tested, particularly in non-malignant diseases. Such models need to be explored further. More work is required on the role of GPNs and how to support them in this role.

  • service evaluation
  • supportive care
  • terminal care
  • symptoms and symptom management
  • home 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.

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