Claire Magee1, Jonathan Koffman2. 1. Community Specialist Palliative Care Team, Coventry, UK. 2. Cicely Saunders Institute, King's College London, UK.
Abstract
OBJECTIVES: Offering genuine choice to patients over place of care and death requires the provision of high-quality palliative care 24/7. This study examines the confidence of out-of-hours general practitioners (GPs) in symptom control and end of life prescribing, and identifies their educational needs and preferences in order to inform recommendations for future education. METHODS: A self-completion postal survey was designed and sent to 1005 GPs working for an independent provider of out-of-hours services across England. Quantitative data were analysed using descriptive statistics and non-parametric tests. RESULTS: 203 (20.3%) GPs completed the survey questionnaire; 13.3% (n=27) worked exclusively out-of-hours. Confidence in assessing palliative care emergencies (42.8%, n=87: 'not so confident' or 'not at all confident'), managing symptoms in non-cancer patients (39.4%, n=80) and prescribing a new syringe driver (39.0%, n=79) was lowest. Lower confidence was associated with infrequent exposure to palliative patients (p<0.05) and lack of training in palliative care (p<0.05); 12.8% (n=26) had never received formal training. Educational preferences were closely associated with confidence (p<0.0005); the topics above were most requested. E-learning was the preferred method (67.5%, n=137). 82.1% (n=165) believed training focused on out-of-hours work would be beneficial. CONCLUSIONS: We identify that confidence in key palliative care competences is severely lacking. Educational strategies to address this concern must be targeted at GPs preferences for content and mode of delivery. Regular e-learning is favoured, but should be blended with other approaches that promote engagement including out-of-hours themed workshops and case discussion. Specialist palliative care services should engage with out-of-hours providers to support education. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
OBJECTIVES: Offering genuine choice to patients over place of care and death requires the provision of high-quality palliative care 24/7. This study examines the confidence of out-of-hours general practitioners (GPs) in symptom control and end of life prescribing, and identifies their educational needs and preferences in order to inform recommendations for future education. METHODS: A self-completion postal survey was designed and sent to 1005 GPs working for an independent provider of out-of-hours services across England. Quantitative data were analysed using descriptive statistics and non-parametric tests. RESULTS: 203 (20.3%) GPs completed the survey questionnaire; 13.3% (n=27) worked exclusively out-of-hours. Confidence in assessing palliative care emergencies (42.8%, n=87: 'not so confident' or 'not at all confident'), managing symptoms in non-cancerpatients (39.4%, n=80) and prescribing a new syringe driver (39.0%, n=79) was lowest. Lower confidence was associated with infrequent exposure to palliative patients (p<0.05) and lack of training in palliative care (p<0.05); 12.8% (n=26) had never received formal training. Educational preferences were closely associated with confidence (p<0.0005); the topics above were most requested. E-learning was the preferred method (67.5%, n=137). 82.1% (n=165) believed training focused on out-of-hours work would be beneficial. CONCLUSIONS: We identify that confidence in key palliative care competences is severely lacking. Educational strategies to address this concern must be targeted at GPs preferences for content and mode of delivery. Regular e-learning is favoured, but should be blended with other approaches that promote engagement including out-of-hours themed workshops and case discussion. Specialist palliative care services should engage with out-of-hours providers to support education. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Authors: Lucy Ellen Selman; Lisa Jane Brighton; Vicky Robinson; Rob George; Shaheen A Khan; Rachel Burman; Jonathan Koffman Journal: BMC Palliat Care Date: 2017-03-09 Impact factor: 3.234
Authors: Anne M Finucane; Anna E Bone; Simon Etkind; David Carr; Richard Meade; Rosalia Munoz-Arroyo; Sébastien Moine; Aghimien Iyayi-Igbinovia; Catherine J Evans; Irene J Higginson; Scott A Murray Journal: BMJ Open Date: 2021-02-03 Impact factor: 2.692
Authors: Simon Schwill; Dorothee Reith; Tobias Walter; Peter Engeser; Michel Wensing; Elisabeth Flum; Joachim Szecsenyi; Katja Krug Journal: BMC Palliat Care Date: 2020-03-24 Impact factor: 3.234
Authors: Anne M Finucane; Anna E Bone; Catherine J Evans; Barbara Gomes; Richard Meade; Irene J Higginson; Scott A Murray Journal: BMC Palliat Care Date: 2019-12-12 Impact factor: 3.234
Authors: K Stichling; M Krause; B Ditscheid; M Hach; M Jansky; M Kaufmann; T Lehmann; W Meißner; F Nauck; W Schneider; S Schulz; H C Vollmar; U Wedding; J Bleidorn; A Freytag Journal: BMC Palliat Care Date: 2020-08-03 Impact factor: 3.234