Primary care physicians (PCPs) frequently have long-term relationships with patients as well as their families. As such they are well positioned to care for their patients at the end of their lives. As the number of patients in need of end-of-life care continues to grow, it is critical to understand how PCPs can fulfill that need. The purpose of our study is to perform a narrative review of the literature and develop a theoretical model delineating the overarching roles played by PCPs in caring for patients at the end of life.
Methods:
For this narrative review, the authors searched Medline (PubMed), Embase, Cochrane Library, and Scopus up to March 22, 2017. Articles were not limited by geography.
Results:
Review of existing literature generally supports 4 broad categories as the primary roles for PCP involvement in end of life: pain and symptom management; information management, including transmitting and clarifying information, setting care priorities, and assisting patients with treatment decisions; coordinating care and collaborating with other providers; and addressing patients’ social, emotional, and spiritual needs.
Conclusions:
Based on the results of this review, PCPs provide a wide range of services to patients at the end of life. Promoting the provision of the full scope of services by PCPs will help ensure improved continuity of care while providing the highest quality of care for patients, both in the United States and around the world.
QuillTEAbernethyAP. Generalist plus specialist palliative care—creating a more sustainable model. N Engl J Med. 2013;368(13):1173–1175.
2.
CurtisJRWenrichMDCarlineJDShannonSEAmbrozyDMRamseyPG. Understanding physicians’ skills at providing end-of-life care. J Gen Intern Med. 2001;16(1):41–49.
3.
NuttingPAGoodwinMAFlockeSAZyzanskiSJStangeKC. Continuity of primary care: to whom does it matter and when?Ann Fam Med. 2003;1(3):149–155.
4.
SteinmetzDWalshMGabelLLWilliamsPT. Family physicians’ involvement with dying patients and their families. Attitudes, difficulties, and strategies. Arch Fam Med. 1993;2(7):753–760; discussion 761.
5.
MitchellSLoewJMillington-SandersCDaleJ. Providing end-of-life care in general practice: findings of a national GP questionnaire survey. Br J Gen Pract. 2016;66(650):e647–e653.
6.
SteinhauserKEChristakisNAClippECMcNeillyMMcIntyreLTulskyJA. Factors considered important at the end of life by patients, family, physicians, and other care providers. JAMA. 2000;284(19):2476–2482.
7.
HanPKJArnoldRM. Palliative care services, patient abandonment, and the scope of physicians’ responsibilities in end-of-life care. J Palliat Med. 2005;8(6):1238–1245.
8.
TenoJMGozaloPLBynumJPW. Change in end-of-life care for Medicare beneficiaries: site of death, place of care, and health care transitions in 2000, 2005, and 2009. JAMA. 2013;309(5):470–477.
9.
MichielsEDeschepperRVan Der KelenG. The role of general practitioners in continuity of care at the end of life: a qualitative study of terminally ill patients and their next of kin. Palliat Med. 2007;21(5):409–415.
10.
HeylandDKDodekPRockerG. What matters most in end-of-life care: perceptions of seriously ill patients and their family members. Can Med Assoc J. 2006;174(5):627–633.
11.
KendallMBoydKCampbellC. How do people with cancer wish to be cared for in primary care? Serial discussion groups of patients and carers. Fam Pract. 2006;23(6):644–650.
12.
SislerJJBrownJBStewartM. Family physicians’ roles in cancer care. Survey of patients on a provincial cancer registry. Can Fam Physician. 2004;50:889–896.
13.
BorgsteedeSDGraafland-RiedstraCDeliensLFranckeALvan EijkJTWillemsDL. Good end-of-life care according to patients and their GPs. Br J Gen Pract. 2006;56(522):20–26.
14.
AspinalFHughesRDunckleyMAddington-HallJ. What is important to measure in the last months and weeks of life? A modified nominal group study. Int J Nurs Stud. 2006;43(4):393–403.
15.
AnkudaCKJettyABazemoreAPettersonS. Provision of palliative care services by family physicians is common. J Am Board Fam Med. 2017;30(2):255–257.
16.
BazemoreAPettersonSPetersonLEPhillipsRL. More comprehensive care among family physicians is associated with lower costs and fewer hospitalizations. Ann Fam Med. 2015;13(3):206–213.
17.
SmythDFarnellADutuGLillisSLawrensonR. Palliative care provision by rural general practitioners in New Zealand. J Palliat Med. 2010;13(3):247–250.
18.
BurgeFLawsonBJohnstonG. Family physician continuity of care and emergency department use in end-of-life cancer care. Med Care. 2003;41(8):992–1001.
19.
SaugoMPellizzariMMarconL. Impact of home care on place of death, access to emergency departments and opioid therapy in 350 terminal cancer patients. Tumori. 2008;94(1):87–95.
20.
AlmaawiyUPondGRSussmanJBrazilKSeowH. Are family physician visits and continuity of care associated with acute care use at end-of-life? A population-based cohort study of homecare cancer patients. Palliat Med. 2014;28(2):176–183.
21.
HigginsonIJSen-GuptaGJ. Place of care in advanced cancer: a qualitative systematic literature review of patient preferences. J Palliat Med. 2000;3(3):287–300.
22.
GomesBCalanzaniNGyselsMHallSHigginsonIJ. Heterogeneity and changes in preferences for dying at home: a systematic review. BMC Palliat Care. 2013;12:7.
23.
NeergaardMAVedstedPOlesenFSokolowskiIJensenABSøndergaardJ. Associations between home death and GP involvement in palliative cancer care. Br J Gen Pract. 2009;59(566):671–677.
24.
BrazilKBedardMWillisonK. Factors associated with home death for individuals who receive home support services: a retrospective cohort study. BMC Palliat Care. 2002;1(1):2.
25.
EvansNCostantiniMPasmanHR. End-of-life communication: a retrospective survey of representative general practitioner networks in four countries. J Pain Symptom Manage. 2014;47(3):604–619.e3.
26.
BeernaertKVan den BlockLVan ThienenK. Family physicians’ role in palliative care throughout the care continuum: stakeholder perspectives. Fam Pract. 2015;32(6):694–700.
27.
BeccaroMLora AprilePScaccabarozziGCancianMCostantiniM. Survey of Italian general practitioners: knowledge, opinions, and activities of palliative care. J Pain Symptom Manage. 2013;46(3):335–344.
28.
FarberNJUrbanSYCollierVUMetzgerMWeinerJBoyerEG. Frequency and perceived competence in providing palliative care to terminally ill patients: a survey of primary care physicians. J Pain Symptom Manage. 2004;28(4):364–372.
29.
GilbertRWillanARRichardsonSSellickS. Survey of family physicians: what is their role in cancer patient care?Can J Oncol. 1994;4(3):285–290.
30.
FerrandEJabrePFernandez-CurielS. Participation of French general practitioners in end-of-life decisions for their hospitalised patients. J Med Ethics. 2006;32(12):683–687.
31.
SnyderSHazelettSAllenKRadwanyS. Physician knowledge, attitude, and experience with advance care planning, palliative care, and hospice: results of a primary care survey. Am J Hosp Palliat Care. 2013;30(5):419–424.
32.
AubinMVézinaLVerreaultR. Patient, primary care physician and specialist expectations of primary care physician involvement in cancer care. J Gen Intern Med. 2012;27(1):8–15.
33.
WangMCMosenDShusterEBellowsJ. Association of patient-reported care coordination with patient satisfaction. J Ambul Care Manage. 2015;38(1):69–76.
34.
CarmontSAMitchellGSeniorHFosterM. Systematic review of the effectiveness, barriers and facilitators to general practitioner engagement with specialist secondary services in integrated palliative care. BMJ Support Palliat Care. 2018;8(4):385–399. doi:10.1136/bmjspcare-2016-001125.
35.
SilveiraMJFormanJ. End-of-life care from the perspective of primary care providers. J Gen Intern Med. 2012;27(10):1287–1293.
36.
SmuckerD. Hospice and the continuum of primary care. Clin Fam Pract. 2004;6(2):299–323.
37.
BarnesEAChowEDanjouxCTsaoM. Collaboration between primary care physicians and radiation oncologists. Ann Palliat Med. 2017;6(1):81–86.
38.
DahlhausAVannemanNGuethlinCBehrendJSiebenhoferA. German general practitioners’ views on their involvement and role in cancer care: a qualitative study. Fam Pract. 2014;31(2):209–214.
39.
AabomBPfeifferP. Why are some patients in treatment for advanced cancer reluctant to consult their GP?Scand J Prim Health Care. 2009;27(1):58–62.
40.
MarshallDHowellDBrazilKHowardMTaniguchiA. Enhancing family physician capacity to deliver quality palliative home care: an end-of-life, shared-care model. Can Fam Physician. 2008;54(12):1703–1703.
41.
BlackfordJStreetA. The role of the palliative care nurse consultant in promoting continuity of end-of-life care. Int J Palliat Nurs. 2001;7(6):273–278.
42.
GardinerCGottMIngletonC. Factors supporting good partnership working between generalist and specialist palliative care services: a systematic review. Br J Gen Pract. 2012;62(598):e353–e362.
43.
OgleKMavisBWangT. Hospice and primary care physicians: attitudes, knowledge, and barriers. Am J Hosp Palliat Care. 2003;20(1):41–51.
44.
ShipmanCGyselsMWhiteP. Improving generalist end of life care: national consultation with practitioners, commissioners, academics, and service user groups. BMJ. 2008;337:a1720.
45.
SchweitzerBBlankensteinNDeliensLvan der HorstH. Out-of-hours palliative care provided by GP co-operatives in the Netherlands: a focus group study. Eur J Gen Pract. 2011;17(3):160–166.
46.
HallSMurchiePCampbellCMurraySA. Introducing an electronic palliative care summary (ePCS) in Scotland: patient, carer and professional perspectives. Fam Pract. 2012;29(5):576–585.
47.
KielyFMurphyMO’BrienT. Information transfer to out-of-hours co-operatives: a survey of general practitioners’ views in relation to palliative patients. BMJ Support Palliat Care. 2013;3(4):405–411.
MurraySAKendallMBoydKWorthABentonTF. General practitioners and their possible role in providing spiritual care: a qualitative study. Br J Gen Pract. 2003;53(497):957–959.
