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. To enhance primary EoLC, the facilitators and barriers to their provision need to be understood.
Objective To provide a comprehensive description of the facilitators and barriers to GP and GPN provision of PC or EoLC.
Method Systematic literature review. Data included papers (2000 to 2017) sought from Medline, PsycInfo, Embase, Joanna Briggs Institute and Cochrane databases.
Results From 6209 journal articles, 62 reviewed papers reported the GP’s and GPN’s role in EoLC or PC practice. Six themes emerged: patient factors; personal GP factors; general practice factors; relational factors; co-ordination of care; availability of services. Four specific settings were identified: aged care facilities, out-of-hours care and resource-constrained settings (rural, and low-income and middle-income countries). Most GPs provide EoLC to some extent, with greater professional experience leading to increased comfort in performing this form of care. The organisation of primary care at practice, local and national level impose numerous structural barriers that impede more significant involvement. There are potential gaps in service provision where GPNs may provide significant input, but there is a paucity of studies describing GPN routine involvement in EoLC.
Conclusions While primary care practitioners have a natural role to play in EoLC, significant barriers exist to improved GP and GPN involvement in PC. More work is required on the role of GPNs.
- chronic conditions
- home care
- education and training
- service evaluation
- supportive care
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.
Correction notice This article has been updated since it was first published. The article type has been changed to Systematic review.
Collaborators May-Lill Johanson, Chalachew Alemayehu.
Contributors GM initiated this study, oversaw the design and conducted all parts of the review, and extensively edited 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. JJR wrote the initial draft of the manuscript. All other authors (MG, HS, LM, PM, CJ, MA, CB, 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.