PT  - JOURNAL ARTICLE
AU  - Nadine Harrison
AU  - Debbie Cavers
AU  - Christine Campbell
AU  - Scott A Murray
TI  - Are UK primary care teams formally identifying patients for palliative care before they die?
AID  - 10.3399/bjgp12X641465
DP  - 2012 May 01
TA  - British Journal of General Practice
PG  - e344--e352
VI  - 62
IP  - 598
4099  - http://bjgp.org/content/62/598/e344.short
4100  - http://bjgp.org/content/62/598/e344.full
SO  - Br J Gen Pract2012 May 01; 62
AB  - Background The palliative care approach has the potential to improve care for patients with progressive life-threatening illnesses from the time of diagnosis. Policy and clinical directives in the UK advocate early identification.Aim To determine the extent to which practices identify patients for palliative care, including factors influencing early identification and possible effects on place of death.Design and setting Qualitative and quantitative data were collected from six general practices from three Scottish NHS boards and analysed.Method Records of patients who had died in the previous 6 months were analysed and interviews with practice staff (n = 21) and with patients currently on the practice palliative care register and bereaved relatives (n = 14) were conducted. In addition, a practice meeting was observed.Results In total, 29% of patients who died were recorded as being on the practice palliative care register before death. Two-thirds of patients with cancer were recorded on the register, but for those with non-malignant conditions only around 20% had any palliative care documented. This was a result of GPs not finding the current guidelines useful and being reluctant to discuss palliative care overtly with patients early in their illness. Palliative care services and documentation were geared towards patients with cancer. More district nurses than GPs saw the benefits of inclusion on the palliative care register. Only 25% of patients on the register died in hospital.Conclusion Most patients with advanced progressive illnesses, especially those with non-malignant disease, are not being formally identified for a palliative care approach before they die. Those identified are more likely to benefit from coordinated care and may be more likely to die at home.