A qualitative study to evaluate the process of identifying patients at the end of life by GPs

Identification of patients who are approaching the end of their life is central to improving end of life (EoL) care. Over 90% of general practices now have an EoL/palliative care register to enable them to undertake advanced planning and ensure that the patient receives the care that they would wish to have, in the place of their choosing. However, it is notoriously difficult to identify which patients are at the end of their life, particularly in patients whose terminal illness is not cancer.

Although numerous studies have been undertaken to review EoL care, there are no published reports specifically focusing on the process of patient identification. This process underpins all strategies to improve EoL care and it is therefore vital to know what the current practice is and what the factors are that either facilitate or obstruct it being carried out effectively.

The study aims to answer the following questions:

1. What are the intrinsic and extrinsic factors that support or obstruct the process of identifying patients at the EoL, and subsequently placing these patients on EoL registers?

2. What are GPs’ views and experiences of identifying patients who are at the EoL?

3. How does the process of identifying patients within different EoL groups (cancer, organ failure, elderly frail/dementia) compare?

4. How are EoL registers populated by GPs?

5. How can education and training for GPs around identification of EoL patients be improved?

Participant recruitment to the study was from practices in Bristol, North Somerset and Somerset.

Purposeful sampling was used to maximise the diversity of views. Interviews were carried out within the GPs' own practices, or on the telephone, and audio recorded then transcribed. Analysis of the data took an inductive, thematic content analysis approach, with coding and identification of analytical categories as they emerged from the data.  Data analysis is still in process.

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