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Systematic review of general practice end-of-life symptom control
  1. Geoffrey K Mitchell1,
  2. Hugh E Senior1,2,
  3. Claire E Johnson3,
  4. Julia Fallon-Ferguson4,5,6,
  5. Briony Williams4,5,6,
  6. Leanne Monterosso7,
  7. Joel J Rhee8,
  8. Peta McVey9,
  9. Matthew P Grant10,
  10. Michèle Aubin11,
  11. Harriet TG Nwachukwu1 and
  12. Patsy M Yates12
    1. 1 Primary Care Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Australia
    2. 2 College of Health, Massey University, Auckland, New Zealand
    3. 3 School of Medicine, University of Western Australia, Perth, Australia
    4. 4 School of General Practice and Rural Medicine, University of Western Australia, Perth, Australia
    5. 5 Primary Care Collaborative Cancer Clinical Trials Group, University of Western Australia, Perth, Australia
    6. 6 Primary Care Collaborative Cancer Clinical Trials Group, University of Melbourne, Melbourne, Australia
    7. 7 School of Nursing, Notre Dame University, Fremantle, Australia
    8. 8 School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
    9. 9 Sydney Nursing School, University of Sydney, Sydney, Australia
    10. 10 School of Medicine, Monash University, Melbourne, Australia
    11. 11 Département de médecine familiale et de médecine d\’urgence, Faculte de medecine, Universite Laval, Québec, Canada
    12. 12 School of Nursing, Queensland University of Technology, Brisbane, Australia
    1. Correspondence to Professor Geoffrey K Mitchell, Primary Care Clinical Unit, University of Queensland, Herston QLD 4072, Australia; g.mitchell{at}


    Background End of life care (EoLC) is a fundamental role of general practice, which will become more important as the population ages. It is essential that general practice’s role and performance of at the end of life is understood in order to maximise the skills of the entire workforce.

    Objective To provide a comprehensive description of the role and performance of general practitioners (GPs) and general practice nurses (GPNs) in EoLC symptom control.

    Method Systematic literature review of papers from 2000 to 2017 were sought from Medline, PsycINFO, Embase, Joanna Briggs Institute and Cochrane databases.

    Results From 6209 journal articles, 46 papers reported GP performance in symptom management. There was no reference to the performance of GPNs in any paper identified. Most GPs expressed confidence in identifying EoLC symptoms. However, they reported lack of confidence in providing EoLC at the beginning of their careers, and improvements with time in practice. They perceived emotional support as being the most important aspect of EoLC that they provide, but there were barriers to its provision. GPs felt most comfortable treating pain, and least confident with dyspnoea and depression. Observed pain management was sometimes not optimal. More formal training, particularly in the use of opioids was considered important to improve management of both pain and dyspnoea.

    Conclusions It is essential that GPs receive regular education and training, and exposure to EoLC from an early stage in their careers to ensure skill and confidence. Research into the role of GPNs in symptom control needs to occur.

    • Primary palliative care
    • general practice
    • general practice nursing
    • pain
    • breathlessness
    • depression (symptoms and symptom management)

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    • Contributors GM initiated this study, oversaw the design and conducted of all parts of the review and wrote the manuscript. JFF and BW did the initial search and screen of ineligible papers. All other authors contributed to the design, the development of the separate research questions, read abstracts, determined eligibility, read full manuscripts, did quality assessments, data extraction and approved the final manuscript.

    • Funding This work was supported by the Royal Australian College of General Practitioner/ HCF grant in 2013.

    • Competing interests None declared.

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

    • Data sharing statement The full dataset of papers is available from the corresponding author.

    • Collaborators Dr May-Lill Johansen, PC4 Palliative Care Working Group.

    • Correction notice This article has been corrected since it published Online First. The third author’s name has been updated to Claire E Johnson