Barriers and Enablers to providing Community Palliative Care to People with Poor Prognosis Cancers: A Survey of Scottish General Practitioners.

Problem

Poor prognosis cancers (PPC) are those where, at diagnosis, the patients are expected to live less than 12 weeks. Around 30,000 people are diagnosed with cancer in Scotland each year, of whom approximately one third live less than one year. With PPC, there is a small window of time from diagnosis until death; this makes delivery of high-quality Palliative and End of Life Care (PEOLC) and Anticipatory Care Planning (ACP) even more difficult. This project aimed to explore GPs’ perspectives of advanced cancer care in the community to inform the development of improved care pathways for patients and families.

Approach

An previously-piloted electronic questionnaire survey was developed and distributed through Qualtrics XL and sent to GPs in Scotland via their regional cancer leads. A response rate could not be calculated as it was not possible to confirm the extent of the survey distribution. Respondents were distributed across all major regions and health boards in Scotland.

Findings

The majority of respondents (80%) reported receiving written communication from Oncology about their patients’ clinical management plans either ‘always’ (30/182, 16%) or ‘most of the time’ (117/182, 64%); only 43% (79/182) and 11% (21/181) received a similar frequency of communication around patient understanding of diagnosis. 72% of respondents reported receiving written ACP communication either ‘sometimes’ (107/181, 59%) or ‘never’ (23/181, 13%). Patients currently receive timely anticipatory care planning (134/161, 83%) and timely clinical assessments for uncontrolled symptoms (156/161, 97%) either ‘always’ or ‘most of the time’.Inadequate GP time (42%) and lack of family support (30%) were most frequently ranked as the #1 barrier to providing PEOLC to people with poor-prognosis cancers. As well as being the single highest-ranked barriers to providing PEOLC to people with poor-prognosis cancers, inadequate GP time and lack of family support were ranked in the ‘top 3’ most impactful barriers to PEOLC by 77% and 60% of respondents, respectively. Challenges in communication, both between primary and secondary care, and between community teams involved in patient care, both ranked in the ‘top 3’ barriers for 44% of respondents. Only a minority of respondents (25%) felt that a lack of specialist palliative care input was a barrier to providing PEOLC to people with poor-prognosis cancers.

Consequences

A lack of adequate GP time and availability of family support were the most common barriers to providing PEOLC for people with PPCs. While this pattern generally persists across GP experience, practice size, and practice rurality, rural GPs felt that lack of family support was a greater barrier than inadequate GP time. Supporting PPC provision in rural settings may require a different intervention. Respondents felt that written communication from Oncology could be improved, particularly in relation to patient understanding of diagnosis and anticipatory care planning conversations.