Palliative care in general practice: what do patients want? A systematic review of the literature

Problem

BackgroundInternationally, general practitioners (GP) have leading responsibility for patient care in the community, and current policy places generalists at the centre of palliative care provision. Little is known about how patients understand their GP's role in delivering palliative care in the community.AimTo explore service user perspectives of the role of the GP in providing palliative care to adult patients in their last years, months and days of life.

Approach

MethodA pre-defined systematic approach was used to appraise relevant studies. From January 2004 to December 2016, 7 electronic databases, including MEDLINE, Embase, PsycINFO, BNI, CINAHL, Cochrane and HMIC were searched using MeSH headings and keywords. Grey literature and guidelines were also searched. Relevant references of articles were assessed and included if appropriate. Data were extracted and tabulated.

Findings

ResultsSeventeen papers met the inclusion criteria, representing the views of patients and their relatives/carers. Thirteen studies employed qualitative methods, three studies collected data using quantitative surveys, and a single study used mixed-methods. Four key aspects of the GP’s role in providing palliative care, as valued by patients/carers, include: knowledge and competence; cross-sectorial cooperation and communication; doctor-patient relationship and continuity; and contact and accessibility.

Consequences

ConclusionThe organisation and focus of primary care is changing, and GPs face increasing challenges to maintain continuity of care. Further research will enable the identification of both what patients expect and want, and in reality what they receive and lack from their GP. It will permit a more tailored, patient-centred approach to service design and delivery.