Information transfer to out-of-hours care for palliative patients is lacking
MedWire News: Information provided by general practitioners (GPs) concerning palliative patients' conditions and management is available in only a minority of cases to out-of-hours services, show Dutch study results.
"Lack of personal contact between professional caregivers might influence the continuity of end-of-life care for the vulnerable group of patients receiving palliative care," suggest Truuske De Bock and co-workers at the University of Groningen in The Netherlands.
The study findings indicate that overall, GPs consider continuity of care during out-of-hours palliative services to be an important issue, but their attitudes toward its organization varies.
The researchers investigated whether, during a period of 3 months in 2006, information on 338 patients receiving palliative care was transferred from their own GP (n=183) to an out-of-hours service, the frequency of transfer, and the content of the information.
The team used an out-of-hours database as well as a GP-directed interview and questionnaire in the analysis.
Patients were aged a median 77 years, 48% were male, and cancer was the most common diagnosis. The most common reasons for an encounter with the out-of-hours service was pain, respiratory symptoms and anxiety, restlessness, and confusion, report the researchers.
In all, 270 (79.9%) patients had no GP handovers available at the time they contacted the out-of-hours service, says the team. Furthermore, among the 107 handovers that were available, just 36.4% contained an "anticipating" end-of-life management plan in terms of prognosis, and only 28.0% had a patient medical history.
An anticipating management plan "ideally includes a description of the patients' understanding of their medical history and condition, values, preferences, and personal, family, and community resources," remark De Bock et al in the journal Family Practice.
The team interviewed a group of 19 individual GPs connected to the out-of-hours database, of whom 41% reported making a handover to the service when they expected their patient to enter the final stages of disease. Of those who did handover, a frequently cited reason was that they did not want their patients to have to re-explain their situation to another doctor.
Barriers cited by GPs to making out-of-hours transfers were technical (bad internet connections, not having enough space to record information), related to time, and the GP not expecting that their patient would die.
The information gathered during the interviews was used to compile a questionnaire, which was returned by 81 GPs, representing 44 of the 52 Dutch out-of-hours services.
Just over three-quarters (76%) of GPs reported transferring information to the out-of-hours service for the majority of their palliative patients, mostly by facsimile (61%), and 20% used the Dutch digital handover system. However, responders were more satisfied with a personal information transfer with a colleague.
GPs also recommended that a checklist be sent electronically or by facsimile to out-of-hours services, a suggestion that increased the number of out-of-hours handovers in England from 21% to 55%.
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By Sarah Guy