Patients’ and carers’ perspectives of palliative care in general practice: a systematic review with narrative synthesis09 Jan 2018
Abstract Background: General practitioners have overall responsibility for community care, including towards end-of-life. Current policy places generalists at the centre of palliative care provision. However, little is known about how patients and carers understand the general practitioner’s role. Aims: To explore patient and carer perspectives of: 1. The role of the general practitioner in providing palliative care to adult patients 2. The facilitators and barriers to the general practitioner’s capacity to fulfil this perceived role Design Systematic literature review and narrative synthesis Data sources: Seven electronic databases (MEDLINE, Embase, PsycINFO, BNI, CINAHL, Cochrane and HMIC) were searched from inception to May 2017. Two reviewers independently screened papers at title, abstract and full-text stages. Grey literature, guideline, hand-searches of five journals, and reference list/citation searches of included papers were undertaken. Data were extracted, tabulated and synthesised using narrative, thematic analysis. Results: 25 studies were included: 14 employed qualitative methods, eight quantitative survey methods and three mixed-methods. Five key themes were identified: continuity of care; communication between primary and secondary care; contact and accessibility; communication between general practitioner and patient; and knowledge and competence. Conclusions: Though the terminology and context of general practice vary internationally, themes relating to the perceived role of general practitioners were consistent. General practitioners are considered well placed to provide palliative care due to their breadth of clinical responsibility, on-going relationships with patients and families, and duty to visit patients at home and coordinate healthcare resources. These factors, valued by service users, should influence future practice and policy development.