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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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.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
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