Improving primary palliative care in Scotland: lessons from a mixed methods study.

Area of Science:

• General Practice
• Palliative Care
• Health Services Research

Background:

• Scotland implemented a Palliative Care Directed Enhanced Service (DES) in 2012 to systematically identify patients for end-of-life care.
• The initiative aimed to improve the identification of patients requiring palliative care within GP practices.

Purpose of the Study:

• To evaluate the impact of the Palliative Care Directed Enhanced Service (DES) on patient identification for palliative care.
• To understand the effectiveness of the DES in identifying patients with both cancer and non-malignant conditions.

Main Methods:

• Analysis of routine quantitative data from the 2012/13 and 2013/14 DES.
• Qualitative analysis of a sample of 2012/13 DES returns using Thematic Analysis.

Main Results:

• In 2012-13, 72% of cancer patients and 27% of non-malignant condition patients were on the palliative care register (PCR).
• By 2013-14, cancer patient identification remained stable, but identification for non-malignant conditions improved to 32.5%.
• Identified needs include training for palliative care identification (especially non-cancer), communication skills, information sharing, district nurse support, IT improvements, and tools for managing larger registers.

Conclusions:

• The DES facilitated generalist palliative care for more patients with long-term conditions (LTC).
• Framing palliative care as anticipatory care can enhance GP communication with patients and families, aiding early identification.
• Improvements in IT and identification tools like SPICT™ can enhance professional communication and patient management.