Table 6

Process and principles to facilitate GP engagement with specialist secondary services in integration of palliative care

AuthorOutcome measuresLength of follow-upResults
Brazil et al 33 Structure of care
Processes of care
Outcomes of care
Core elements of a model to improve delivery of palliative care include:Integration of the family physician with a palliative care team
  • Interprofessional training—single point of access to specialist team

  • 24/7 access

  • Adjustment in funding to allow collaborative practices

  • Funding for patients for equipment, supplies and medication

  • Standardised assessment tools

  • Team meetings

  • Practice-based education by a palliative care physician

  • Common patient records

  • Assessing the quality of care provided to patients and families

  • Integrating continuous quality improvement

Stewart et al 26 Participation
Professional development
Hospice impact
Patient impact
Evaluated at 14 monthsCommunication between services is effective, a sense of partnership reported. Professional development: training has been extremely useful with enhanced knowledge, increased confidence and familiarity with hospice staff
Hospice impact: referrals have decreased however complexity has increased
Linkages: a strengthening of service relationships has been claimed, with the role of patient care coordinator being responsible for this. No data were provided to support this.
Mason et al 34 Ethnographic observations for 22 weeks. Interviews conducted 8–12 weeks intervals for 5–9 months or until death.
Interviews with professionals completed once.
Patient identification must precede coordination of care. Mismatch between policy and guidance around identifying patients for palliative care and the actual practice of identification
Palliative care was often thought of when no cure is possible and death is imminent by patients and carers.
In most cases the family carer or patient was the coordinator of care.
Patients with a nurse specialist felt better cared for.
GP was sometimes recognised as playing a key role but usually only consulted for acute problems.
After discharge patients were disturbed by lack of follow-up from GP.
Walshe et al 28 GSF has improved interprofessional communication, a positive impact on previously difficult communication.
GSF provides structure, authority and permission to arrange formal meetings and informal communications.
Impact of GSF on provision of anticipatory drugs is positive.
GSF has adverse effect on workloads.
GSF lead by specialist palliative care practitioners.
GSF is adapted over time to suit the professionals involved.
  • GP, general practitioner; GSF, Gold Standard Framework.