TY - JOUR T1 - Hidden pain and palliative care in general practice out-of-hours attendances by patients with advanced cancer: an analysis of coded and uncoded free-text data JF - British Journal of General Practice JO - Br J Gen Pract DO - 10.3399/BJGP.2022.0084 SP - BJGP.2022.0084 AU - Sarah Mills AU - Alana Brown-Kerr AU - Deans Buchanan AU - Peter T Donnan AU - Blair H Smith Y1 - 2022/11/01 UR - http://bjgp.org/content/early/2022/11/01/BJGP.2022.0084.abstract N2 - Background: People with advanced cancer frequently use the GP Out-of-Horus (GPOOH) service. Significant amounts of routine GPOOH data are uncoded, and therefore omitted from existing healthcare datasets. Aim: To conduct a free-text analysis of a GPOOH dataset, to identify reasons for attendance and care delivered through GPOOH to people with advanced cancer. Design and setting: Analysis of GPOOH healthcare dataset containing all coded and free-text information for 5,749 attendances, from a cohort of 2,443 people who died from cancer in Tayside, Scotland in 2012-2015. Method: Random sampling methods selected 575 consultations for free-text analysis, each analysed by two independent reviewers, to determine assigned presenting complaints, key and additional palliative care symptoms recorded in free-text, evidence of anticipatory care planning and free-text recording of dispensed medications. Interrater reliability concordance established through Kappa testing. Results: Over half of all coded reasons for attendance (n=293, 51.0%) were ‘other’ or missing. Free-text analysis demonstrated that nearly half (n=284, 49.4%) of GPOOH attendances by people with advanced cancer were for pain or palliative care. More than half of GPOOH attendances (n=325, 56.5%) recorded at least one key or additional palliative care symptom in free-text, with the commonest being breathlessness, nausea, vomiting and cough. Anticipatory care planning was poorly recorded in both coded and uncoded records. Uncoded medications were dispensed in over a quarter of GPOOH consultations. Conclusion: GPOOH delivers a substantial amount of pain management and palliative care, much of which is uncoded and therefore unrecognised and under-reported in existing large healthcare data analyses. ER -