Helping GPs identify more patients for palliative care planning

One of the greatest challenges that family doctors face is identifying which of their patients has palliative care needs.

While family doctors are now well aware how to identify patients with terminal cancer who need palliative care, they struggle to do the same for patients with other terminal illnesses. What’s more, although research has recently shown that palliative care can even prolong life, for many it is still thought of as a “death sentence.”

So, not only is it difficult for family doctors to identify who to help in this way it is even more difficult to know how to communicate this to those who might benefit.

How research can help

At the Primary Palliative Care Research Group at the University of Edinburgh, we've recently looked at this thorny issue and came up with a computer search that provides a list of registered patients who might have such needs. To see how it might work and what benefits it might give, we tested it in a variety of ways in 12 different practices in two areas of Scotland.

There were two key parts to this. One was to use only software and computer systems that were already in place at GP surgeries and which would need NO extra programming or user skills. The other was to focus on how GPs could use the search in practice. Too many IT developments in the NHS have been “software centred.” We aimed to be user-centred.

What the results tell us

We have recently published an article explaining our results, which were promising and a little unexpected.

The search was definitely able to identify patients with palliative care needs. When GPs and other clinicians looked at the results for their practices they generally agreed with one-third to two-thirds of the patients on the search results.

What was interesting about this is that GPs weren’t surprised by the names on the list. The GPs had previously realised that these patients had additional needs of some sort so the search results acted as a trigger to upgrade their cases.

What was unexpected and very positive was that most times the GPs agreed on a plan of “anticipatory care”, which allowed them to use a palliative approach in their care. This meant that they could start assessing holistically and planning ahead to meet the patient’s and carer’s goals immediately, instead of needing to start formal “palliative care” right away.

GPs sought consent to let a “Key Information Summary” be shared with out of hours and secondary care. GPs also paid a lot of attention to the patient’s family circumstance, especially if someone who lived with them had health problems of their own. These kinds of help are exactly the ones that patients have told us they would welcome.

These early findings are promising and we are now building a more sophisticated version of the search to see if we can refine how useful the search is. Please feel free to follow the progress on our twitter account. We'd love to hear from you.

Read our Triggers for palliative report to see how Marie Curie is helping to improve access to care for people with terminal diseases other than cancer. You can also read more about our partnership with the Royal College of GPs.