Structured implementation of the Supportive and Palliative Care Indicators Tool in general practice – A prospective interventional study with follow-up
Abstract Background General practitioners (GPs) play a key role in the provision of primary palliative care (PC). The identification of patients who might benefit from PC and the timely initiation of patient-centred PC measures at the end of life are essential, yet challenging. Although different to...
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| Format: | Article |
| Language: | English |
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BMC
2022-12-01
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| Series: | BMC Palliative Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12904-022-01107-y |
| _version_ | 1811207531117150208 |
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| author | Kambiz Afshar Katharina van Baal Birgitt Wiese Tanja Schleef Stephanie Stiel Gabriele Müller-Mundt Nils Schneider |
| author_facet | Kambiz Afshar Katharina van Baal Birgitt Wiese Tanja Schleef Stephanie Stiel Gabriele Müller-Mundt Nils Schneider |
| author_sort | Kambiz Afshar |
| collection | DOAJ |
| description | Abstract Background General practitioners (GPs) play a key role in the provision of primary palliative care (PC). The identification of patients who might benefit from PC and the timely initiation of patient-centred PC measures at the end of life are essential, yet challenging. Although different tools exist to support these key tasks, a structured approach is often missing. Objective The study aimed at implementing the German version of the Supportive and Palliative Care Indicators Tool (SPICT-DE™) in general practices, following a structured and regional approach, in order to evaluate the effects of this tool on the identification of patients with potential PC needs and the initiation of patient-centred PC measures. Methods The intervention of this mixed-methods study comprised a standardised training of 52 GPs from 34 general practices in two counties in Lower Saxony, Germany, on the use of the SPICT-DE™. The SPICT-DE™ is a clinical tool which supports the identification of patients with potential PC needs. Subsequently, over a period of 12 months, GPs applied the SPICT-DE™ in daily practice with adult patients with chronic, progressive diseases, and completed a follow-up survey 6 months after the initial patient assessment. The outcome parameters were alterations in the patient’s clinical situation, and the type and number of initiated patient-centred PC measures during the follow-up interval. Additionally, 12 months after the standardised training, GPs provided feedback on their application of the SPICT-DE™. Results A total of 43 GPs (n = 15 female, median age 53 years) out of an initial sample of 52 trained GPs assessed 580 patients (n = 345 female, median age 84 years) with mainly cardiovascular (47%) and cancer (33%) diseases. Follow-up of 412 patients revealed that 231 (56%) experienced at least one critical incident in their disease progression (e.g. acute crisis), 151 (37%) had at least one hospital admission, and 141 (34%) died. A review of current treatment/medication (76%) and a clarification of treatment goals (53%) were the most frequently initiated patient-centred PC measures. The majority of GPs deemed the SPICT-DE™ practical (85%) and stated an intention to continue applying the tool in daily practice (66%). Conclusions The SPICT-DE™ is a practical tool that supports the identification of patients at risk of deterioration or dying and promotes the initiation of patient-centred PC measures. Trial registration The study was registered in the German Clinical Trials Register (N° DRKS00015108; 22/01/2019). |
| first_indexed | 2024-04-12T04:06:06Z |
| format | Article |
| id | doaj.art-2312ec263a1649b598fb10a5fd754e30 |
| institution | Directory Open Access Journal |
| issn | 1472-684X |
| language | English |
| last_indexed | 2024-04-12T04:06:06Z |
| publishDate | 2022-12-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Palliative Care |
| spelling | doaj.art-2312ec263a1649b598fb10a5fd754e302022-12-22T03:48:37ZengBMCBMC Palliative Care1472-684X2022-12-0121111310.1186/s12904-022-01107-yStructured implementation of the Supportive and Palliative Care Indicators Tool in general practice – A prospective interventional study with follow-upKambiz Afshar0Katharina van Baal1Birgitt Wiese2Tanja Schleef3Stephanie Stiel4Gabriele Müller-Mundt5Nils Schneider6Institute for General Practice and Palliative Care, Hannover Medical SchoolInstitute for General Practice and Palliative Care, Hannover Medical SchoolInstitute for General Practice and Palliative Care, Hannover Medical SchoolInstitute for General Practice and Palliative Care, Hannover Medical SchoolInstitute for General Practice and Palliative Care, Hannover Medical SchoolInstitute for General Practice and Palliative Care, Hannover Medical SchoolInstitute for General Practice and Palliative Care, Hannover Medical SchoolAbstract Background General practitioners (GPs) play a key role in the provision of primary palliative care (PC). The identification of patients who might benefit from PC and the timely initiation of patient-centred PC measures at the end of life are essential, yet challenging. Although different tools exist to support these key tasks, a structured approach is often missing. Objective The study aimed at implementing the German version of the Supportive and Palliative Care Indicators Tool (SPICT-DE™) in general practices, following a structured and regional approach, in order to evaluate the effects of this tool on the identification of patients with potential PC needs and the initiation of patient-centred PC measures. Methods The intervention of this mixed-methods study comprised a standardised training of 52 GPs from 34 general practices in two counties in Lower Saxony, Germany, on the use of the SPICT-DE™. The SPICT-DE™ is a clinical tool which supports the identification of patients with potential PC needs. Subsequently, over a period of 12 months, GPs applied the SPICT-DE™ in daily practice with adult patients with chronic, progressive diseases, and completed a follow-up survey 6 months after the initial patient assessment. The outcome parameters were alterations in the patient’s clinical situation, and the type and number of initiated patient-centred PC measures during the follow-up interval. Additionally, 12 months after the standardised training, GPs provided feedback on their application of the SPICT-DE™. Results A total of 43 GPs (n = 15 female, median age 53 years) out of an initial sample of 52 trained GPs assessed 580 patients (n = 345 female, median age 84 years) with mainly cardiovascular (47%) and cancer (33%) diseases. Follow-up of 412 patients revealed that 231 (56%) experienced at least one critical incident in their disease progression (e.g. acute crisis), 151 (37%) had at least one hospital admission, and 141 (34%) died. A review of current treatment/medication (76%) and a clarification of treatment goals (53%) were the most frequently initiated patient-centred PC measures. The majority of GPs deemed the SPICT-DE™ practical (85%) and stated an intention to continue applying the tool in daily practice (66%). Conclusions The SPICT-DE™ is a practical tool that supports the identification of patients at risk of deterioration or dying and promotes the initiation of patient-centred PC measures. Trial registration The study was registered in the German Clinical Trials Register (N° DRKS00015108; 22/01/2019).https://doi.org/10.1186/s12904-022-01107-yPalliative careEnd-of-life careGeneral practicePrimary carePatient-centred care |
| spellingShingle | Kambiz Afshar Katharina van Baal Birgitt Wiese Tanja Schleef Stephanie Stiel Gabriele Müller-Mundt Nils Schneider Structured implementation of the Supportive and Palliative Care Indicators Tool in general practice – A prospective interventional study with follow-up BMC Palliative Care Palliative care End-of-life care General practice Primary care Patient-centred care |
| title | Structured implementation of the Supportive and Palliative Care Indicators Tool in general practice – A prospective interventional study with follow-up |
| title_full | Structured implementation of the Supportive and Palliative Care Indicators Tool in general practice – A prospective interventional study with follow-up |
| title_fullStr | Structured implementation of the Supportive and Palliative Care Indicators Tool in general practice – A prospective interventional study with follow-up |
| title_full_unstemmed | Structured implementation of the Supportive and Palliative Care Indicators Tool in general practice – A prospective interventional study with follow-up |
| title_short | Structured implementation of the Supportive and Palliative Care Indicators Tool in general practice – A prospective interventional study with follow-up |
| title_sort | structured implementation of the supportive and palliative care indicators tool in general practice a prospective interventional study with follow up |
| topic | Palliative care End-of-life care General practice Primary care Patient-centred care |
| url | https://doi.org/10.1186/s12904-022-01107-y |
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