Skip to main content
Top
Published in: BMC Palliative Care 1/2016

Open Access 01-12-2016 | Research article

Timely identification of palliative patients and anticipatory care planning by GPs: practical application of tools and a training programme

Authors: Bregje Thoonsen, Marieke Groot, Stans Verhagen, Chris van Weel, Kris Vissers, Yvonne Engels

Published in: BMC Palliative Care | Issue 1/2016

Login to get access

Abstract

Background

Palliative care is mainly restricted to terminal care. General practitioners (GPs) are not trained to early identify palliative patients with cancer, COPD or heart failure. With the help of the RADboud indicators for PAlliative Care needs (RADPAC), we trained GPs to identify patients’ needs and to make a proactive care plan. They were also able to join two role-plays where they discussed the patient’s future, and consulted a palliative care consultant to fine-tune the care plan. We evaluated the programme with the GPs and consultants and noted its impact on their daily practice.

Methods

Two years after they had participated in the programme, we held semi-structured interviews with the GPs and a focus group interview with the consultants and performed a thematic content analysis.

Results

Six consultants and nine GPs participated in the programme. Most GPs and consultants mentioned positive changes in the thinking or acting of GPs regarding early palliative care. A number continued to use the tool to identify patients; most of the others noted they had internalised the indicators. Although half of them still considered discussing end-of-life aspects difficult, particularly in patients with organ failure, the others were more easily able to discuss the future with their palliative patients.

Conclusion

Although most GPs and consultants were positive about the training programme and applying it in daily practice, we conclude that in future programmes, more attention needs to paid to timely identification of palliative patients with COPD or CHF and how to discuss the future with them.
Appendix
Available only for authorised users
Literature
2.
go back to reference Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010;363:733–42.CrossRefPubMed Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010;363:733–42.CrossRefPubMed
3.
go back to reference Bakitas M, Lyons KD, Hegel MT, Brokaw FC, Seville J, et al. Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: the Project ENABLE II randomized controlled trial. JAMA. 2009;302:741–9.CrossRefPubMedPubMedCentral Bakitas M, Lyons KD, Hegel MT, Brokaw FC, Seville J, et al. Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: the Project ENABLE II randomized controlled trial. JAMA. 2009;302:741–9.CrossRefPubMedPubMedCentral
4.
go back to reference Zimmermann C, Swami N, Krzyzanowska M, Hannon B, Leighl N, Oza A, et al. Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial. Lancet. 2014;383:1721–30.CrossRefPubMed Zimmermann C, Swami N, Krzyzanowska M, Hannon B, Leighl N, Oza A, et al. Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial. Lancet. 2014;383:1721–30.CrossRefPubMed
5.
go back to reference De Roo ML, Miccinesi G, Onwuteaka-Philipsen BD, Van Den Noortgate N, Van den Block L, Bonacchi A, et al. Actual and preferred place of death of home-dwelling patients in four European countries: making sense of quality indicators. PLoS One. 2014;9:e93762.CrossRefPubMedPubMedCentral De Roo ML, Miccinesi G, Onwuteaka-Philipsen BD, Van Den Noortgate N, Van den Block L, Bonacchi A, et al. Actual and preferred place of death of home-dwelling patients in four European countries: making sense of quality indicators. PLoS One. 2014;9:e93762.CrossRefPubMedPubMedCentral
6.
go back to reference Osse BH, Vernooij-Dassen MJ, Schade E, Grol RP. A practical instrument to explore patients’ needs in palliative care: the Problems and Needs in Palliative Care questionnaire short version. Palliat Med. 2007;21:391–9.CrossRefPubMed Osse BH, Vernooij-Dassen MJ, Schade E, Grol RP. A practical instrument to explore patients’ needs in palliative care: the Problems and Needs in Palliative Care questionnaire short version. Palliat Med. 2007;21:391–9.CrossRefPubMed
7.
go back to reference van der Plas AG, Hagens M, Pasman HR, Schweitzer B, Duijsters M, Onwuteaka-Philipsen BD. PaTz groups for primary palliative care: reinventing cooperation between general practitioners and district nurses in palliative care: an evaluation study combining data from focus groups and a questionnaire. BMC Fam Pract. 2014;15:14.CrossRefPubMedPubMedCentral van der Plas AG, Hagens M, Pasman HR, Schweitzer B, Duijsters M, Onwuteaka-Philipsen BD. PaTz groups for primary palliative care: reinventing cooperation between general practitioners and district nurses in palliative care: an evaluation study combining data from focus groups and a questionnaire. BMC Fam Pract. 2014;15:14.CrossRefPubMedPubMedCentral
8.
go back to reference Slort W, Blankenstein AH, Schweitzer BP, Deliens L, van der Horst HE. Effectiveness of the ‘availability, current issues and anticipation’ (ACA) training programme for general practice trainees on communication with palliative care patients: a controlled trial. Patient Educ Couns. 2014;95:83–90.CrossRefPubMed Slort W, Blankenstein AH, Schweitzer BP, Deliens L, van der Horst HE. Effectiveness of the ‘availability, current issues and anticipation’ (ACA) training programme for general practice trainees on communication with palliative care patients: a controlled trial. Patient Educ Couns. 2014;95:83–90.CrossRefPubMed
9.
go back to reference Thoonsen B, Engels Y, van Rijswijk E, Verhagen S, van Weel C, Groot M, et al. Early identification of palliative care patients in general practice: development of RADboud indicators for PAlliative Care Needs (RADPAC). Br J Gen Pract. 2012;62:e625–31.CrossRefPubMedPubMedCentral Thoonsen B, Engels Y, van Rijswijk E, Verhagen S, van Weel C, Groot M, et al. Early identification of palliative care patients in general practice: development of RADboud indicators for PAlliative Care Needs (RADPAC). Br J Gen Pract. 2012;62:e625–31.CrossRefPubMedPubMedCentral
10.
go back to reference Thoonsen B, Groot M, Engels Y, Prins J, Verhagen S, Galesloot C, et al. Early identification of and proactive palliative care for patients in general practice, incentive and methods of a randomized controlled trial. BMC Fam Pract. 2011;12:123.CrossRefPubMedPubMedCentral Thoonsen B, Groot M, Engels Y, Prins J, Verhagen S, Galesloot C, et al. Early identification of and proactive palliative care for patients in general practice, incentive and methods of a randomized controlled trial. BMC Fam Pract. 2011;12:123.CrossRefPubMedPubMedCentral
11.
go back to reference Thoonsen B, Vissers K, Verhagen S, Prins J, Bor H, Van Weel C, et al. Training general practitioners in early identification and anticipatory palliative care planning: a randomized controlled trial. BMC Fam Pract. 2015;16:126.CrossRefPubMedPubMedCentral Thoonsen B, Vissers K, Verhagen S, Prins J, Bor H, Van Weel C, et al. Training general practitioners in early identification and anticipatory palliative care planning: a randomized controlled trial. BMC Fam Pract. 2015;16:126.CrossRefPubMedPubMedCentral
12.
go back to reference Greenhalgh T, Annandale E, Ashcroft R, Barlow J, Black N, Bleakley A, et al. An open letter to The BMJ editors on qualitative research. BMJ. 2016;352:i563.CrossRefPubMed Greenhalgh T, Annandale E, Ashcroft R, Barlow J, Black N, Bleakley A, et al. An open letter to The BMJ editors on qualitative research. BMJ. 2016;352:i563.CrossRefPubMed
13.
go back to reference Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19:349–57.CrossRefPubMed Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19:349–57.CrossRefPubMed
14.
go back to reference Braun V, Clarke V. Using thematic content analysis in psychology. Qual Res Psychol. 2006;3:77–101.CrossRef Braun V, Clarke V. Using thematic content analysis in psychology. Qual Res Psychol. 2006;3:77–101.CrossRef
15.
go back to reference Shaw EA, Marshall D, Howard M, Taniguchi A, Winemaker S, Burns S. A systematic review of postgraduate palliative care curricula. J Palliat Med. 2010;13:1091–108.CrossRefPubMed Shaw EA, Marshall D, Howard M, Taniguchi A, Winemaker S, Burns S. A systematic review of postgraduate palliative care curricula. J Palliat Med. 2010;13:1091–108.CrossRefPubMed
16.
go back to reference Alvarez MP, Agra Y. Systematic review of educational interventions in palliative care for primary care physicians. Palliat Med. 2006;20:673–83.CrossRefPubMed Alvarez MP, Agra Y. Systematic review of educational interventions in palliative care for primary care physicians. Palliat Med. 2006;20:673–83.CrossRefPubMed
17.
go back to reference Fitzsimons D, Mullan D, Wilson JS, Conway B, Corcoran B, Dempster M, et al. The challenge of patients’ unmet palliative care needs in the final stages of chronic illness. Palliat Med. 2007;21:313–22.CrossRefPubMed Fitzsimons D, Mullan D, Wilson JS, Conway B, Corcoran B, Dempster M, et al. The challenge of patients’ unmet palliative care needs in the final stages of chronic illness. Palliat Med. 2007;21:313–22.CrossRefPubMed
18.
go back to reference Harding R, Selman L, Beynon T, Hodson F, Coady E, Read C, et al. Meeting the communication and information needs of chronic heart failure patients. J Pain Symptom Manag. 2008;36:149–56.CrossRef Harding R, Selman L, Beynon T, Hodson F, Coady E, Read C, et al. Meeting the communication and information needs of chronic heart failure patients. J Pain Symptom Manag. 2008;36:149–56.CrossRef
19.
go back to reference Janssen DJ, Curtis JR, Au DH, Spruit MA, Downey L, Schols JM, et al. Patient-clinician communication about end-of-life care for Dutch and US patients with COPD. Eur Respir J. 2011;38:268–76.CrossRefPubMed Janssen DJ, Curtis JR, Au DH, Spruit MA, Downey L, Schols JM, et al. Patient-clinician communication about end-of-life care for Dutch and US patients with COPD. Eur Respir J. 2011;38:268–76.CrossRefPubMed
20.
go back to reference Mason B, Boyd K, Murray SA, Steyn J, Cormie P, Kendall M, et al. Developing a computerised search to help UK General Practices identify more patients for palliative care planning: a feasibility study. BMC Fam Pract. 2015;16:99.CrossRefPubMedPubMedCentral Mason B, Boyd K, Murray SA, Steyn J, Cormie P, Kendall M, et al. Developing a computerised search to help UK General Practices identify more patients for palliative care planning: a feasibility study. BMC Fam Pract. 2015;16:99.CrossRefPubMedPubMedCentral
21.
go back to reference Duenk RG, Heijdra Y, Verhagen SC, Dekhuijzen RP, Vissers KC, Engels Y. PROLONG: a cluster controlled trial to examine identification of patients with COPD with poor prognosis and implementation of proactive palliative care. BMC Pulm Med. 2014;14:54.CrossRefPubMedPubMedCentral Duenk RG, Heijdra Y, Verhagen SC, Dekhuijzen RP, Vissers KC, Engels Y. PROLONG: a cluster controlled trial to examine identification of patients with COPD with poor prognosis and implementation of proactive palliative care. BMC Pulm Med. 2014;14:54.CrossRefPubMedPubMedCentral
23.
24.
go back to reference Randall CJ. Palliative care for patients with chronic obstructive pulmonary disease. Respir Med. 2006;2:5. Randall CJ. Palliative care for patients with chronic obstructive pulmonary disease. Respir Med. 2006;2:5.
25.
go back to reference Vernooij-Dassen MJ, Groot MM, van den Berg J, Kuin A, van der Linden BA, van Zuylen L, et al. Consultation in palliative care: the relevance of clarification of problems. Eur J Cancer. 2007;43:316–22.CrossRefPubMed Vernooij-Dassen MJ, Groot MM, van den Berg J, Kuin A, van der Linden BA, van Zuylen L, et al. Consultation in palliative care: the relevance of clarification of problems. Eur J Cancer. 2007;43:316–22.CrossRefPubMed
28.
go back to reference van Riet PJ, Vernooij-Dassen M, Sommerbakk R, Moyle W, Hjermstad MJ, Leppert W, et al. Implementation of improvement strategies in palliative care: an integrative review. Implement Sci. 2015;10:103.CrossRef van Riet PJ, Vernooij-Dassen M, Sommerbakk R, Moyle W, Hjermstad MJ, Leppert W, et al. Implementation of improvement strategies in palliative care: an integrative review. Implement Sci. 2015;10:103.CrossRef
29.
go back to reference O’Cathain A, Murphy E, Nicholl J. Three techniques for integrating data in mixed methods studies. BMJ. 2010;341:c4587.CrossRefPubMed O’Cathain A, Murphy E, Nicholl J. Three techniques for integrating data in mixed methods studies. BMJ. 2010;341:c4587.CrossRefPubMed
Metadata
Title
Timely identification of palliative patients and anticipatory care planning by GPs: practical application of tools and a training programme
Authors
Bregje Thoonsen
Marieke Groot
Stans Verhagen
Chris van Weel
Kris Vissers
Yvonne Engels
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Palliative Care / Issue 1/2016
Electronic ISSN: 1472-684X
DOI
https://doi.org/10.1186/s12904-016-0112-9

Other articles of this Issue 1/2016

BMC Palliative Care 1/2016 Go to the issue