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BMC Palliative Care
Published in: BMC Palliative Care 1/2022

Open Access 01-12-2022 | Care | Research

Structured implementation of the Supportive and Palliative Care Indicators Tool in general practice – A prospective interventional study with follow-up

Authors: Kambiz Afshar, Katharina van Baal, Birgitt Wiese, Tanja Schleef, Stephanie Stiel, Gabriele Müller-Mundt, Nils Schneider

Published in: BMC Palliative Care | Issue 1/2022

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Abstract

Background

General practitioners (GPs) play a key role in the provision of primary palliative care (PC). The identification of patients who might benefit from PC and the timely initiation of patient-centred PC measures at the end of life are essential, yet challenging. Although different tools exist to support these key tasks, a structured approach is often missing.

Objective

The study aimed at implementing the German version of the Supportive and Palliative Care Indicators Tool (SPICT-DE™) in general practices, following a structured and regional approach, in order to evaluate the effects of this tool on the identification of patients with potential PC needs and the initiation of patient-centred PC measures.

Methods

The intervention of this mixed-methods study comprised a standardised training of 52 GPs from 34 general practices in two counties in Lower Saxony, Germany, on the use of the SPICT-DE™. The SPICT-DE™ is a clinical tool which supports the identification of patients with potential PC needs. Subsequently, over a period of 12 months, GPs applied the SPICT-DE™ in daily practice with adult patients with chronic, progressive diseases, and completed a follow-up survey 6 months after the initial patient assessment. The outcome parameters were alterations in the patient’s clinical situation, and the type and number of initiated patient-centred PC measures during the follow-up interval. Additionally, 12 months after the standardised training, GPs provided feedback on their application of the SPICT-DE™.

Results

A total of 43 GPs (n = 15 female, median age 53 years) out of an initial sample of 52 trained GPs assessed 580 patients (n = 345 female, median age 84 years) with mainly cardiovascular (47%) and cancer (33%) diseases. Follow-up of 412 patients revealed that 231 (56%) experienced at least one critical incident in their disease progression (e.g. acute crisis), 151 (37%) had at least one hospital admission, and 141 (34%) died. A review of current treatment/medication (76%) and a clarification of treatment goals (53%) were the most frequently initiated patient-centred PC measures. The majority of GPs deemed the SPICT-DE™ practical (85%) and stated an intention to continue applying the tool in daily practice (66%).

Conclusions

The SPICT-DE™ is a practical tool that supports the identification of patients at risk of deterioration or dying and promotes the initiation of patient-centred PC measures.

Trial registration

The study was registered in the German Clinical Trials Register (N° DRKS00015108; 22/01/2019).
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Metadata
Title
Structured implementation of the Supportive and Palliative Care Indicators Tool in general practice – A prospective interventional study with follow-up
Authors
Kambiz Afshar
Katharina van Baal
Birgitt Wiese
Tanja Schleef
Stephanie Stiel
Gabriele Müller-Mundt
Nils Schneider
Publication date
01-12-2022
Publisher
BioMed Central
Keyword
Care
Published in
BMC Palliative Care / Issue 1/2022
Electronic ISSN: 1472-684X
DOI
https://doi.org/10.1186/s12904-022-01107-y

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