Facilitators and barriers to general practitioner and general practice nurse participation in end-of-life care: systematic review

As population aging increases, general practitioners (GPs) and general practice nurses (GPNs) face increasing demands to provide palliative care (PC) or end-of-life care (EoLC).  To understand the barriers and facilitators to their provision among GPs and GPNs, researchers conducted a systematic review. They found that continuity of care with the GP/GPN was affected by patient characteristics, patient needs and the willingness of GP/GPs to conduct EoLC. Patients with cancer were more likely than patients without cancer to receive GP PC in the last 3 months of life as were older patients with cancer. They also reported that non-malignant conditions including dementia were less likely than patients with cancer to receive sufficient care. Over 90% of GPs were willing to provide EoLC, particularly to patients with advanced cancer, including in resource-poor settings. While rural Australian GPs regarded EoLC as a core part of their work, about 25% of urban GPs did not offer EoLC. Lack of time or personal commitments were stated barriers. These GPs handed PC over completely to specialist PC teams. These results suggest that GPs are involved in PC or EoLC in cancer patients, however, lack of time was a barrier to provision. In future, more work is required on the role of GPNs to understand the barriers and facilitators to their provision of PC or EoLC.

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