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Many people in Scotland now benefit from anticipatory care before they die: an after death analysis and interviews with general practitioners
  1. Julia Tapsfield1,
  2. Charlie Hall2,
  3. Carey Lunan3,
  4. Hazel McCutcheon3,
  5. Peter McLoughlin4,
  6. Joel Rhee5,
  7. Alfonso Leiva6,7,
  8. Juliet Spiller2,
  9. Anne Finucane2 and
  10. Scott A Murray1
  1. 1 Primary Palliative Care Research Group, Centre for Population Health Sciences, The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
  2. 2 Marie Curie Hospice Edinburgh, Edinburgh, UK
  3. 3 NHS Lothian, Edinburgh, UK
  4. 4 Department in Strategic Planning and Modernisation, Lothian NHS Board, Edinburgh, UK
  5. 5 School of Public Health & Community Medicine, The University of New South Wales, Sydney, New South Wales, Australia
  6. 6 Primary Care Research Unit of Mallorca, Baleares Health Services-IbSalut, Palma, Spain
  7. 7 Instituto de Investigación Sanitaria de Palma, Palma, Spain
  1. Correspondence to Professor Scott A Murray, Primary Palliative Care Research Group, Centre for Population Health Sciences, The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, EH8 9AG, UK; Scott.Murray{at}ed.ac.uk

Abstract

Background Key Information Summaries (KIS) were introduced throughout Scotland in 2013 so that anticipatory care plans written by general practitioners (GPs) could be routinely shared electronically and updated in real time, between GPs and providers of unscheduled and secondary care.

Aims We aimed to describe the current reach of anticipatory and palliative care, and to explore GPs’ views on using KIS.

Methods We studied the primary care records of all patients who died in 2014 in 9 diverse Lothian practices. We identified if anticipatory or palliative care had been started, and if so how many weeks before death and which aspects of care had been documented. We interviewed 10 GPs to understand barriers and facilitating factors.

Results Overall, 60% of patients were identified for a KIS, a median of 18 weeks before death. The numbers identified were highest for patients with cancer, with 75% identified compared with 66% of those dying with dementia/frailty and only 41% dying from organ failure. Patients were more likely to die outside hospital if they had a KIS. GPs identified professional, patient and societal challenges in identifying patients for palliative care, especially those with non-cancer diagnoses.

Conclusions GPs are identifying patients for anticipatory and palliative care more equitably across the different disease trajectories and earlier in the disease process than they were previously identifying patients specifically for palliative care. However, many patients still lack care planning, particularly those dying with organ failure.

  • Supportive care
  • Chronic conditions
  • Home care
  • Service evaluation
  • Terminal care

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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