Table 2

Details of studies of GP engagement with specialist secondary services in integration of palliative care

Title, author, dateStudy design and aimStudy qualityParticipants and settingIntervention and control
RCTs
Delivery strategies to optimize resource utilization and performance status for patients with advanced life-limiting illness: Results from the “Palliative Care Trial”
Abernethy et al, 20132
2 by 2 factorial cluster RCT
Aim: to improve on current models of service provision
Jadad 4/5461 participants, 358 assigned to case conferences (167 receiving case conferences). 103 assigned no case conference.
Inclusion: new referrals to the palliative care service with any pain in the past 3 months; expected to live at least 48 hours; residing in service's geographic area; Folstein mini mental score 24+.
Average patient age of 71, 53% male, 59% married, 94% have caregiver, 91% cancer diagnosis.
Setting: urban community-based, specialised palliative care in South Australia
Control: current specialised palliative care provided by a regional community-based palliative care programme
Three concurrent intervention in a 2×2×2 factorial randomised study. Intervention 1 is relevant.
Intervention: current care+case conferencing (single case conference between GP and palliative specialist team)
Randomized, controlled trial of integrated heart failure management
Doughty et al, 200222
Cluster RCT
Aim: determine the effect of an integrated heart failure management programme on quality of life and death and hospital readmissions in patients with chronic heart failure
Jadad 4/5197 hospital inpatients with heart failure
Age range 34–92, 79 female, 70 living alone, 43 patients died prior to 12-month follow-up, one other lost to follow-up
Exclusions: surgical remediable cause of heart failure; consideration for heart transplant; inability to provide informed consent; terminal cancer; and/or participation in any other clinical trial
Intervention: within 2 weeks of discharge attend clinic review; education sessions with cardiologist and nurse; 6 weekly follow-up; detailed letter sent to GP with telephone communication with GP if changes to care needed; communication encouraged
Control: continued under care of their GP with additional follow-up measures as usually recommended by medical team responsible for inpatient care
Do case conferences between general practitioners and specialist palliative services improve quality of life? A randomised controlled trial
Mitchell et al, 200824
RCT—unit of randomisation was GP/patient dyad.
Aim: to test whether case conferences for palliative patients between GPs and specialist teams could improve patient Quality of life and reduce strain of caring for the primary carers
Jadad 5/5159 patients: 79 intervention and 80 control.
Demographics were similar across intervention GPs: 101 participated. 62 had 1 patient, 26 had 2 and 11 had 3. Intervention and control GPs were similar.
Setting: 3 hospital-based palliative care services across 3 hospital sites supporting GPs and home based nurse care
Intervention: GP was encouraged to participate in a case conference with the specialist team to negotiate a treatment plan with the GP playing an active part. Subsequent communication followed normal practice. Control : normal care
Cohort studies
Case conferences between general practitioner and specialist teams to plan end of life care of people with end stage heart failure and lung disease: an exploratory pilot study
Mitchell et al, 201423
Cohort study
Aim: to assess the effectiveness of case conferences between specialist teams and GP in improving patient outcomes for people with end stage heart failure and lung disease
CASP 11/12Participants: 23 patients (21 GPs) with a primary diagnosis of advanced heart failure or respiratory failure from non-malignant disease with a life expectancy of <12 months.
Setting: The Heart Failure and Lung Health service in the West Moreton Health and Hospital Service District, Queensland, Australia
Intervention: case conference at the GPs office with the GP, palliative care physician and the case management nurse from the heart/lung service. Case conference was guided by a semistructured case conference schedule and a care plan developed including actions and responsibilities.
Surveys
Who is the key worker in palliative home care?
Brogaard et al, 201131
Survey and interview
Aim: explore who acts as key worker and who ought to act as key worker in views of patients, relatives and primary care professionals
Critical appraisal of a survey 10/1296 terminally ill cancer patients, their relatives, their GPs and their CNsNot applicable
Cooperating with a palliative home-care team: expectations and evaluations of GPs and district nurses
Goldschmidt et al, 200525
Survey
Aim: evaluate a palliative home care team from the viewpoint of GPs and district nurses
Critical appraisal of a survey 6/12GPs that attended the home conference between July 2000 and June 2003. GPs were excluded if their patient had been in contact with the department for more than 3 months, did not meet inclusion criteria or had been visited by the home care team prior to the home conference. 213 GPs and 212 were eligible. 82 GPs and 163 nurses received questionnaire and 75 GPs and 148 district nurses completed Q1. 204 GPs eligible for Q2 and 139 DNs; 143GPs and 101 DNs completed Q2
Setting: Hospital Department of Palliative medicine, Copenhagen, Denmark
Patients are referred to the palliative care home team. The team visits the patient at home and on the first meeting the patient’s relatives, GP, district nurses also attend. The home team visit the patient on a regular basis and propose treatment changes to GPs and nurses.
Obstacles to the delivery of primary palliative care as perceived by GPs
Groot et al, 200735
Survey
Aim: identify obstacles which hinder the delivery of primary palliative care
Critical appraisal of a survey 9/12All GPs practising in 3 regions in the Netherlands were sent a questionnaires (n=320)
Setting: 3 regions of the Netherlands
Comparison of services, no control
What information do general practitioners need to care for patients with lung cancer? A survey of general practitioners perceptions
Rowlands et al, 201030
Survey
Aim: to establish the patient information needs of GPs within the context of multidisciplinary care
Critical appraisal of a survey 8/12All GPs practising in one Australian regional Division of General Practice, excluding specialty clinics (eg, skin cancer)—433 GPs approached
Setting: one regional Division of General Practice in Australia
Qualitative
Palliative care case conferencing involving general practice: an argument for a facilitated standard process
Davison and Shelby-James, 201236
Qualitative analysis
Aim: raise the understanding of case conferencing for palliative care patients and to recommend improvements to the process
CASP 8/1017 GP-led case conferences including GP, palliative specialist team, patient and/or carer—transcripts of full case conference
Setting: an interdisciplinary, community-based, specialised palliative care service servicing a metropolitan population of 350 000 in South Australia
Case conference with GP, palliative specialist team and patient/carer
Coordination of care for individuals with advanced progressive conditions: a multi-site ethnographic and serial interview study
Mason et al, 200734
Mixed-methods study including ethnographic study and qualitative semistructured interviews
Aim: to identify how care is coordinated in generalist settings for individuals with advanced progressive conditions in the last year of life
CASP 8/1056 patients and 25 carers participated in interviews. One-off interviews were conducted with 17 clinicians (GPs and palliative specialists.
Setting: 3 UK generalist clinical settings—an acute admissions unit, a general practice and a respiratory outpatient service
Comparison of services
General practitioner, specialist providers case conferences in palliative care
Mitchell et al, 200527
Qualitative
semistructured interviews
focus groups
Aim: describe the utility and acceptability to GPs and palliative care staff of case conferences in palliative care
CASP 10/1041 GPs who participated in case conferences
16 palliative care staff who participated in case conferences
Setting: 3 hospital-based palliative care services across 3 hospital sites supporting GPs and home-based nurse care
Intervention: GP was encouraged to participate in a case conference with the specialist team to negotiate a treatment plan. Subsequent communication followed normal practice
Control: normal care
Family physicians and cancer care. Palliative care patient’s perspectives
Norman et al, 200132
Qualitative: semistructured interviews and chart reviews
Aim: to explore factors that affect the integrity of palliative cancer patients’ relationships with FPs and their perspectives of their FP roles
CASP 8/10A purposive sampling of 11 men and 14 women
Setting: 2 palliative care hospital wards in Winnipeg, Manitoba
Analysis of current care programme
Communication issues for the interdisciplinary community palliative care team
Street and Blackford, 200129
Qualitative
semistructured interviews and focus group interviews
Aim: examine the communication patters between nurses and GPs in providing palliative care
CASP 8/1040 nurses recruited through presentations in education programmes and distribution of pamphlets. Purposive sampling ensured all the metropolitan hospice and palliative care services were represented.Analysis of care within metropolitan area
Discovering integrated care in community hospitals
Tucker, 201337
Qualitative—questionnaire
Aim: explore the presence and nature of integrated care in community hospitals
CASP 7/1048 staff members voluntarily returned questionnaires. Number approached not included, however invitation to participate was purposive. It was found that they were representative of the diversity of hospitals in terms of type, geography and size.
Community Hospital Services across the England
Analysis of current care programme
Implementation and impact of the Gold Standards Framework in community palliative care: a qualitative study of three primary care trusts
Walshe et al, 200828
Qualitative
semistructured interviews
Aim: describe the reasons and influences on the referral decisions made by healthcare professionals providing community general and specialist palliative care services
CASP 8/1047 healthcare professionals (general and specialist palliative care) from 3 Primary Care Trusts in North West EnglandComparison of services, no control
Narrative
Building Primary Care Capacity in Palliative Care: Proceedings of an Interprofessional Workshop
Brazil et al, 200733
Workshop proceedings
Aim: to enhance the capacity of primary care for the terminally ill
JBI NOTARI 4/5Setting: 3 primary palliative care demonstration projects in Ontario, CanadaAnalysis of 3 separate projects to identify and disseminate key learnings
Palliative Care Partnership: a successful model of primary/secondary integration
Stewart et al, 200626
Narrative and surveyJB NOTARI 5/6Setting: mid central health district NZ.
Participating organisations: Arohanui Hospice and General Practice teams
Participants: 225 patients in 14 months (cancer patients, cardiovascular disease patients, respiratory patients, renal, dementia, neurological and other)
To detail the development and implementation of a primary secondary integration project in palliative care
  • CASP, Critical Appraisal Skills Programme; DN, district nurses; FP, family physician; GP, general practitioner; JBI NOTARI, Joanna Briggs Institutes Narrative, Opinion and Text Assessment and Review Instrument; NZ, New Zealand; RCT, randomised controlled trial.