1. Specialist palliative care support | A Dutch specialist palliative care support service offered symptom management advice, and end-of-life advice to GPs32 Approximately 30% of French GPs were actively consulted when making decision to cease active treatment. 60% were phoned to get GP views prior to hospital staff making the decision. Most GPs had a role in explaining the decision to bereaved relatives35
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2. Pain and symptom management | |
a. Pain relief | Limited improvement with patient education in pain management vs usual care15 No improvement with GP education in pain management vs usual care15 Improvement in pain at 3 weeks with primary and palliative home care programme compared with baseline33 Implementation of a clinical pathway for pain management in a rural palliative care service in Japan improved compliance with WHO pain management guidelines, and improved pain outcomes compared with before implementation36
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b. Function | |
2. Symptom control/management | Half of patients with head and neck cancer had unresolved symptoms despite regular GP contact with the head and neck team31 Anxiety, depression and tiredness significantly decreased following intervention with symptom reductions seen at 3 weeks and maintained at 12 weeks (p<0.01)33 Loss of appetite trended towards an overall significant decrease at 3 weeks and showed significant reductions at 12-week follow-up34 GP facilitator programme (UK-MacMillan) did not improve GP confidence in symptom management or the ability to communicate a serious diagnosis27 Participation in a national end-of-life programme improved clinical practice, but not confidence27 No significant changes in symptom burden, mood, quality of life or spiritual distress at 6 or 12 months with shared geriatrician/palliative care34 Most users of a Dutch telephone advice service were GPs caring for patients at home. The most frequent advice was for pain (49%), delirium (20%), nausea and vomiting (16%), and dyspnoea (12%). Fourteen per cent were for advice on end-of-life issues (terminal sedation 11% and euthanasia 3%)31
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3. Achieved preferred place of death | 69% of patients achieved preferred place of death when practice involved in Gold Standards Framework or other end-of-life frameworks (47% at home). GSF involvement had greatest relationship with achieving preferred place of death29 Half of Dutch patients with head and neck cancer died at home (under care of GP), with phone communication with head and neck team. GPs happy with quality of care provided33
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4. Adherence to clinical palliative care process guidelines | GSF appeared to lead to more palliative care standards being met in improved communication, teamwork, patient identification, assessment, care planning and carer support than in matched practices28 Implementation of a clinical pathway for pain management in a rural palliative care service in Japan improved compliance with WHO pain management guidelines36 GP palliative care registers contained mainly cancer sufferers, despite their representing a small proportion of GP deaths30 GPs used intuition more than formal clinical guidelines to identify people at risk of dying30
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5. Service utilisation | 26% reduction in hospitalisations with single GP case conference in a specialist palliative care population (RCT)15 82% reduction in annual hospitalisation rate after single GP case conference (before-and-after study)25 26 Cost savings per patient of $AU 25 274 after a single GP case conference26 No change in the level of service utilisation with shared care between PC specialist and community-based geriatrician34
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