چکیده (انگلیسی):

Background:Since 2012, all GP practices across Scotland have been supported to take a systematic approach to
end-of-life care, by helping them to identify more patients for palliative care through a Palliative Care Directed
Enhanced Service (DES). We aimed to understand the impact of this initiative.
Methods:Routine quantitative data from the 2012/13, and 2013/14 DES were collected from regional health boards,
analysed and discussed. Qualitative data were collected from a sample of 2012/13 DES returns and analysed using
Thematic Analysis.
Results:Data were received from 512 practices in nine Scottish Health boards for the 2012-13 DES and 638 practices in
11 Health boards for 2013-14. A sample of 90 of the returns for 2012-13 was selected for qualitative analysis.
In 2012-13, 72 % of patients who died of cancer were listed on the palliative care register (PCR) before death while
27 % of patients who died as a result of non-malignant conditions were listed on the PCR. In 2013-14, cancer
identification remained the same but identification of people dying with other long-term conditions had improved to
32.5 %.
We identified several key issues needed to improve palliative care in the community. The need for training to identify
patients with palliative care needs (particularly non-cancer); communication skills training; improvements in sharing
information across the NHS; under-resource of and lack of coordination with district nurses; improvements in
information technology; and tools for working with enlarged palliative care registers.
Conclusions:The DES helped more patients with long-term conditions (LTC) receive generalist palliative care.
Approaching generalist palliative care as anticipatory care could facilitate communication between GPs and patients/
families and remove some barriers to early identification of palliative care needs. Improvement of information
technology and use of identification tools like the SPICT™may improve professionals’ communication with each other
and help may make identification and management of patients easier.