Role and response of primary healthcare services in community end-of-life care during COVID-19: Qualitative study and recommendations for primary palliative care delivery. (February 2023)

• Record Type: Journal Article
• Authors: Turner, Nicola; Wahid, Aysha; Oliver, Phillip; Gardiner, Clare; Chapman, Helen; Khan (PPI co-author), Dena; Boyd, Kirsty; Dale, Jeremy; Barclay, Stephen; Mayland, Catriona R; Mitchell, Sarah J
• Is Part Of: Palliative medicine. Volume 37:Number 2(2023)
• Page Start: 235
• Page End: 243
• Publication Date: 2023-02
• Subjects: Palliative care -- terminal care -- COVID-19 -- primary health care -- general practice -- primary care nursing -- qualitative research; Pain -- Treatment -- Periodicals; Cancer -- Palliative treatment -- Periodicals; Palliative Care -- Periodicals; Palliatieve behandeling; 616.029
• DOI: 10.1177/02692163221140435
• Languages: English
• ISSNs: 0269-2163

Abstract

Background: The need for end-of-life care in the community increased significantly during the COVID-19 pandemic. Primary care services, including general practitioners and community nurses, had a critical role in providing such care, rapidly changing their working practices to meet demand. Little is known about primary care responses to a major change in place of care towards the end of life, or the implications for future end-of-life care services. Aim: To gather general practitioner and community nurse perspectives on factors that facilitated community end-of-life care during the COVID-19 pandemic, and to use this to develop recommendations to improve future delivery of end-of-life care. Design: Qualitative interview study with thematic analysis, followed by refinement of themes and recommendations in consultation with an expert advisory group. Participants: General practitioners ( n = 8) and community nurses ( n = 17) working in primary care in the UK. Results: General practitioner and community nurse perspectives on factors critical to sustaining community end-of-life care were identified under three themes: (1) partnership working is key, (2) care planning for end-of-life needs improvement, and (3) importance of the physical presence of primary care professionals. Drawing on participants' experiences and behaviour change theory, recommendations are proposed to improve end-of-life care in primary care. Conclusions: To sustain and embed positive change, an increased policy focus on primary care in end-of-life care is required. Targeted interventions developed during COVID-19, including online team meetings and education, new prescribing systems and unified guidance, could increase capacity and capability of the primary care workforce to deliver community end-of-life care.