The role and response of primary healthcare services in community end-of-life care during COVID-19: What can be learned and embedded to improve future care?

Conference:

SAPC ASM 2022 - UCLan

Talk Code:

1E.3

Presenter:

Sarah Mitchell

Twitter:

@MacGPSarah

Co-authors:

Sarah Mitchell (1) Aysha Wahid (1) Nicola J Turner (1), Phillip Oliver (1), Clare Gardiner (1), Catriona R Mayland (1), Helen Chapman (2), Dena Khan (3), Kirsty Boyd (4), Stephen Barclay (5), Jeremy Dale (6).

Author institutions:

1. University of Sheffield, 2. Sheffield Teaching Hospitals Integrated Care Team, 3. PPI co-author, 4. University of Edinburgh, 5. University of Cambridge, 6. University of Warwick.

Problem

There has been a 41% increase in the number of people dying at home, including in care homes, during the COVID-19 pandemic. General practitioners and community nurses have rapidly changed the way in which they have delivered end-of-life care during the pandemic, but this has been the subject of very little research during COVID-19 and previous pandemics. The aims of this study are: 1. To build upon a UK survey of primary healthcare professionals with an in-depth exploration of the beneficial service changes for community end-of-life care during COVID-19 from a primary care perspective. 2. To develop recommendations to improve the primary care delivery of end-of-life care in the future, including during pandemics, drawing upon behaviour change theory.

Approach

Semi-structured qualitative interview study to elicit in-depth, detailed insights. Thematic analysis conducted by the research team was followed by refinement of themes and recommendations in consultation with an expert advisory group.

Findings

GPs (n=8) and community nurses (n=15) working in primary care across the UK. Expert advisory group of GPs (n=3), public health consultant (n=1) and specialist palliative care consultants (n=2). Interview participants reported significant practical and emotional challenges in providing community end-of-life during the COVID-19 pandemic. Three inter-related themes emerged to describe critical success factors for sustaining community end-of-life care from a primary care perspective: (1) partnership working is key to community end-of-life care, (2) COVID-19 highlighted the need to improve advance planning for end-of-life care, and (3) the importance of the presence of primary care professionals in end-of-life care must be recognised.

Consequences

In order to embed positive change, recommendations include increased policy focus on building capability and opportunity to capitalise upon the motivation of the primary care workforce to provide end-of-life care. The potential for increased use of technology to enable a multi-disciplinary team approach and to deliver education and training requires more research and investment. New systems that enable palliative care in primary care developed during the pandemic include access to medicines and time for care planning. The leadership role of general practitioners in end-of-life care within primary care teams, and in healthcare organisations, is important and enables collaborative guideline and policy development for end-of-life care. Future research should include the perspective of patients and families, and the wider primary healthcare team including community pharmacists.

Submitted by:

Sarah Mitchell

Funding acknowledgement:

This research was funded by the Scientific Foundation Board of the Royal College of General Practitioners (Grant No SFB 2020 – 11).