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Improving generalist end of life care: national consultation with practitioners, commissioners, academics and service user group

Improving generalist end of life care: national consultation with practitioners, commissioners, academics and service user group
Improving generalist end of life care: national consultation with practitioners, commissioners, academics and service user group
Objective: to identify major concerns of national and local importance in the provision, commissioning, research, and use of generalist end of life care.
Design: a national consultation and prioritising exercise using a modified form of the nominal group technique.
Participants: healthcare practitioners, commissioners, academics, and representatives of user and voluntary groups.
Setting: primary and secondary care, specialist palliative care, and academic and voluntary sectors in England and Scotland.
Results: 74% of those invited (210/285) participated. The stage of life to which "end of life care" referred was not understood in a uniform way. Perceptions ranged from a period of more than a year to the last few days of life. Prominent concerns included difficulties in prognosis and the availability of adequate support for patients with advanced non-malignant disease. Generalists in both primary and secondary care were usually caring for only a few patients approaching the end of life at any one time at a point in time. It was therefore challenging to maintain skills and expertise particularly as educational opportunities were often limited. End of life care took place among many other competing and incentivised activities for general practitioners in the community. More needs to be known about models of end of life care and how these can be integrated in a generalist’s workload. A greater evidence base is needed about the effectiveness and application of current tools such as the gold standards framework and Liverpool care pathway and about models of palliation in patients with diseases other than cancer.
Conclusions: definitions of end of life care need clarification and standardisation. A greater evidence base is needed to define models of good practice together with a commitment to provide education and training and adequate resources for service provision. More needs to be known about the context of provision and the influence of competing priorities and incentives
0959-8138
8pp
Shipman, Cathy
4508f5e7-c5b1-4955-af5d-431878d74e1a
Gysels, Marjolein
54b0973c-096d-422a-94d3-5103431b8b5f
White, Patrick
aa8d0bb0-0a13-4c57-8b3b-e8fa19b46b93
Worth, Allison
b70ca906-2d55-4b37-ad1b-19f41b09212a
Murray, Scott A.
ebaa905d-c95f-4ec5-951b-9f7341673db1
Barclay, Scott
557ebc98-ff74-45ec-9cdd-ac2e63e1d062
Forrest, Sarah
85a049e9-42fa-4bcb-a8cb-ce47debdcdd2
Shepherd, Jonathan
4f0ed9b0-03de-4084-abde-9a65b97afeb5
Dale, Jeremy
19fccbd2-1661-4d84-8a94-36bedb12a0e2
Dewar, Steve
81a27b3d-e45b-4108-8189-b6d3d7bd7b8c
Peters, Marilyn
a0859f6f-9a31-4a3c-9dfb-a1d128aaf9c8
White, Suzanne
dcadb3b6-c41f-407a-939e-1636bf8d8f6e
Richardson, Alison
3db30680-aa47-43a5-b54d-62d10ece17b7
Lorenz, Karl
235d27bd-c387-4b1b-83b1-d18baa70073c
Koffman, Jonathan
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Higginson, Irene J.
8bff8e06-57f3-491b-ab81-2ecf983f52f3
Shipman, Cathy
4508f5e7-c5b1-4955-af5d-431878d74e1a
Gysels, Marjolein
54b0973c-096d-422a-94d3-5103431b8b5f
White, Patrick
aa8d0bb0-0a13-4c57-8b3b-e8fa19b46b93
Worth, Allison
b70ca906-2d55-4b37-ad1b-19f41b09212a
Murray, Scott A.
ebaa905d-c95f-4ec5-951b-9f7341673db1
Barclay, Scott
557ebc98-ff74-45ec-9cdd-ac2e63e1d062
Forrest, Sarah
85a049e9-42fa-4bcb-a8cb-ce47debdcdd2
Shepherd, Jonathan
4f0ed9b0-03de-4084-abde-9a65b97afeb5
Dale, Jeremy
19fccbd2-1661-4d84-8a94-36bedb12a0e2
Dewar, Steve
81a27b3d-e45b-4108-8189-b6d3d7bd7b8c
Peters, Marilyn
a0859f6f-9a31-4a3c-9dfb-a1d128aaf9c8
White, Suzanne
dcadb3b6-c41f-407a-939e-1636bf8d8f6e
Richardson, Alison
3db30680-aa47-43a5-b54d-62d10ece17b7
Lorenz, Karl
235d27bd-c387-4b1b-83b1-d18baa70073c
Koffman, Jonathan
2d600f6f-40aa-4734-8c9e-cc777a417fe5
Higginson, Irene J.
8bff8e06-57f3-491b-ab81-2ecf983f52f3

Shipman, Cathy, Gysels, Marjolein, White, Patrick, Worth, Allison, Murray, Scott A., Barclay, Scott, Forrest, Sarah, Shepherd, Jonathan, Dale, Jeremy, Dewar, Steve, Peters, Marilyn, White, Suzanne, Richardson, Alison, Lorenz, Karl, Koffman, Jonathan and Higginson, Irene J. (2008) Improving generalist end of life care: national consultation with practitioners, commissioners, academics and service user group. British Medical Journal, 337 (a1720), 8pp. (doi:10.1136/bmj.a1720).

Record type: Article

Abstract

Objective: to identify major concerns of national and local importance in the provision, commissioning, research, and use of generalist end of life care.
Design: a national consultation and prioritising exercise using a modified form of the nominal group technique.
Participants: healthcare practitioners, commissioners, academics, and representatives of user and voluntary groups.
Setting: primary and secondary care, specialist palliative care, and academic and voluntary sectors in England and Scotland.
Results: 74% of those invited (210/285) participated. The stage of life to which "end of life care" referred was not understood in a uniform way. Perceptions ranged from a period of more than a year to the last few days of life. Prominent concerns included difficulties in prognosis and the availability of adequate support for patients with advanced non-malignant disease. Generalists in both primary and secondary care were usually caring for only a few patients approaching the end of life at any one time at a point in time. It was therefore challenging to maintain skills and expertise particularly as educational opportunities were often limited. End of life care took place among many other competing and incentivised activities for general practitioners in the community. More needs to be known about models of end of life care and how these can be integrated in a generalist’s workload. A greater evidence base is needed about the effectiveness and application of current tools such as the gold standards framework and Liverpool care pathway and about models of palliation in patients with diseases other than cancer.
Conclusions: definitions of end of life care need clarification and standardisation. A greater evidence base is needed to define models of good practice together with a commitment to provide education and training and adequate resources for service provision. More needs to be known about the context of provision and the influence of competing priorities and incentives

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Published date: October 2008

Identifiers

Local EPrints ID: 69376
URI: https://eprints.soton.ac.uk/id/eprint/69376
ISSN: 0959-8138
PURE UUID: 0e787c8c-e71c-4d6a-85f5-ed9dd51b1906
ORCID for Alison Richardson: ORCID iD orcid.org/0000-0003-3127-5755

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Date deposited: 10 Nov 2009
Last modified: 03 Dec 2019 01:42

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Contributors

Author: Cathy Shipman
Author: Marjolein Gysels
Author: Patrick White
Author: Allison Worth
Author: Scott A. Murray
Author: Scott Barclay
Author: Sarah Forrest
Author: Jonathan Shepherd
Author: Jeremy Dale
Author: Steve Dewar
Author: Marilyn Peters
Author: Suzanne White
Author: Karl Lorenz
Author: Jonathan Koffman
Author: Irene J. Higginson

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