Aims To investigate the effective undertaking and recording of end of life conversations within a busy urban general practice. These included important areas such as physical, psychological, social, spiritual and financial concerns as well as DNAR decisions and preferred place of care.
Methods Utilising EMIS database, all deaths between the 1 st January 2016 and 31 st December 2016 of patients registered at Newington Road Surgery, Ramsgate were identified. The electronic notes and records were accessed and reviewed. A total of 63 deaths were recorded.
Results In 54% of deaths in the practice, end of life discussions would have been appropriate because of evidence of general decline, end stage cancer or frailty. Despite this only 38% of these patients had end of life discussions.
Out of these discussions 62% focused on physical symptoms with only 38% recording psychological, social, financial or spiritual discussions.
Most surprisingly only 9% of patients had a saved and accessible care plan and none of those plans recorded had any information regarding patient‘s preferred place of care, preferred place of death or an escalation plan regarding hospital admissions.
Conclusions This project concluded that many factors are involved when contributing to discussions had by GPs towards the end of patient‘s lives. These included time pressures and the need for additional input from hospital, oncology and palliative care teams.
However, this project highlighted the importance in identifying patients towards the end of their life in the community (and the use of approved tools such as SPICT) and the need for increased education for GPs about all aspects of supportive end of life care and advanced care planning.
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