Skip to main content

Generalist palliative care for non-cancer patients

A review article

Hausärztliche Palliativversorgung bei nichtonkologischen Patienten

Eine Übersichtsarbeit

Abstract

Background

Most patients in the last phase of life can be treated in the context of generalist palliative care, especially by general practitioners. In contrast to specialized palliative care, non-cancer patients predominate in this setting.

Objective

The aim of this article is to review the literature and elaborate current topics for non-cancer patients at the end-of-life in primary palliative care.

Materials and methods

A literature search was carried out in the databases PubMed and Scopus from 2008 to 2013 followed by a qualitative content analysis according to the PRISMA statement.

Results

A total of 127 articles could be included in the qualitative content analysis and the final review whereby four core topics were identified: (1) specific target groups (e. g. elderly patients, patients with advanced heart failure and pain), (2) collaboration of general practitioners with other physicians and health professionals, (3) qualifications in palliative care and (4) provision of primary palliative care. Most articles found were related to the fourth topic and the subtopic of barriers and facilitators of palliative care. Insufficient coordination of the persons involved was a barrier often discussed. Advanced care planning including concrete palliative care aspects at an early stage can be beneficial for both patients and professionals.

Conclusion

The current literature search highlights the importance of optimizing the processes and structures in providing palliative care and the discussion of end-of-life issues at an early stage in general practice. Therefore, a structured identification of palliative care needs identified by appropriate assessment instruments is crucial.

Zusammenfassung

Hintergrund

Die meisten Patienten können in ihrer letzten Lebensphase im Rahmen der allgemeinen Palliativversorgung v. a. durch Hausärzte betreut werden. Dabei überwiegen – im Gegensatz zur spezialisierten Palliativmedizin – Patienten mit nichtonkologischen Erkrankungen.

Ziel der Arbeit

Basierend auf einer Literaturanalyse präsentiert dieser Beitrag aktuelle Themen der Forschungsliteratur zur hausärztlichen Versorgung dieser Patientengruppe am Lebensende.

Material und Methoden

Es erfolgten eine Literaturrecherche in den Datenbanken PubMed und Scopus für den Zeitraum 2008 bis 2013 sowie formale und inhaltsanalytische Auswertungen entlang der Kriterien des PRISMA-Statements.

Ergebnisse

Es wurden 127 Artikel in die inhaltliche Analyse und den finalen Review eingeschlossen. Vier thematische Schwerpunkte wurden herausgearbeitet: 1) spezifische Zielgruppen (z. B. hochaltrige Patienten, Patienten mit fortgeschrittener Herzinsuffizienz, Schmerzpatienten), 2) Zusammenarbeit von Hausärzten mit anderen Ärzten und Gesundheitsprofessionen, 3) palliativmedizinische Qualifizierung sowie 4) Betreuung von Palliativpatienten in der Praxis. Zum vierten Themenkomplex und insbesondere der Untergruppe „Barrieren und fördernde Aspekte der Palliativversorgung“ fanden sich die meisten Arbeiten. Eine zentrale Barriere besteht in einer ungenügenden Koordination der beteiligten Akteure. Förderlich ist eine frühzeitige, vorausschauende Versorgungsplanung, in der konkrete Aspekte einer späteren Palliativversorgung thematisiert werden.

Schlussfolgerungen

Die aktuelle Forschungsliteratur verdeutlicht die Wichtigkeit einer Optimierung von Versorgungsstrukturen und -prozessen sowie einer frühzeitigen Auseinandersetzung mit Themen des Lebensendes in der hausärztlichen Praxis. Hierfür ist eine strukturierte Identifikation des palliativen Versorgungsbedarfs unter Einsatz von geeigneten Erhebungsinstrumenten zielführend.

This is a preview of subscription content, access via your institution.

Fig. 1

References

  1. 1.

    Radbruch L, Payne S (2009) White paper on standards and norms for hospice and palliative care in Europe: Part 1. Europ J Palliat Care 16:278–289

    Google Scholar 

  2. 2.

    Kassenärztliche Bundesvereinigung (2014) Einheitlicher Bewertungsmaßstab. (EBM, Stand 1. Quartal) http://www.kbv.de/media/sp/Einheitlicher_Bewertungsma_stab_Stand_2014_1._Quartal.pdf. Accessed 20. Mai 2016

    Google Scholar 

  3. 3.

    Bleeker F, Kruschinski C, Breull A, Berndt M, Hummers-Pradier E (2007) Charakteristika hausärztlicher Palliativpatienten. Z Allg Med 83:477–482

    Article  Google Scholar 

  4. 4.

    Schneider N, Mitchell GK, Murray SA (2010) Palliative care in urgent need of recognition and development in general practice: the example of Germany. BMC Fam Pract 11:66

    Article  PubMed  PubMed Central  Google Scholar 

  5. 5.

    Kratel U (2014) Fortschritte in der ambulanten Palliative Care – Versorgung in Deutschland – Eine Bestandsaufnahme. DZO 46(01):8–15

    Article  Google Scholar 

  6. 6.

    Schneider N, Buser K, Amelung VE (2006) Ansichten von Hausärzten zur Versorgung von unheilbar kranken Patienten am Lebensende – Ergebnisse einer Befragung in Niedersachsen. Z Allg Med 82:289–304

    Article  Google Scholar 

  7. 7.

    Lunney JR, Lynn J, Foley DS, Lipson S, Guralnik JM (2003) Patterns of functional decline at the end of life. JAMA 289:2387–2392

    Article  PubMed  Google Scholar 

  8. 8.

    Murray SA, Kendall M, Boyd K, Sheikh A (2005) Illness trajectories and palliative care. Clinical Review. BMJ 330:1007–1011

    Article  PubMed  PubMed Central  Google Scholar 

  9. 9.

    Moher D, Liberati A, Tetzlaff J, Altman DG, Group PRISMA (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535

    Article  PubMed  PubMed Central  Google Scholar 

  10. 10.

    Deutscher Bundestag (2009) Gutachten 2009 des Sachverständigenrates zur Begutachtung der Entwicklung im Gesundheitswesen. (Drucksache 16/13770) http://dip21.bundestag.de/dip21/btd/16/137/1613770.pdf. Accessed 20. Mai 2016

    Google Scholar 

  11. 11.

    Behmann M, Jünger S, Radbruch L, Schneider N (2012) Public health actions to improve palliative care in Germany: results of a three-round Delphi study. Health Policy (New York) 106:303–312

    Article  Google Scholar 

  12. 12.

    In der Schmitten J, Lex K, Mellert C, Rothärmel S, Wegscheider K, Marckmann G (2014) Implementing an advance care planning program in German nursing homes: results of an inter-regionally controlled intervention trial. Dtsch Arztebl Int 111:50–57

    PubMed  PubMed Central  Google Scholar 

  13. 13.

    Ostgathe C, Alt-Epping B, Golla H, Gaertner J, Lindena G, Radbruch L, Voltz R, Hospice and Palliative Care Evaluation (HOPE) Working Group (2011) Non-cancer patients in specialized palliative care in Germany: what are the problems? Palliat Med 25:148–152

    Article  PubMed  Google Scholar 

  14. 14.

    Kaasa S, Torvik K, Cherny N, Hanks G, Conno F de (2007) Patient demographics and centre description in European palliative care units. Palliat Med 21:15–22

    Article  PubMed  Google Scholar 

  15. 15.

    Blinderman CD, Homel P, Billings JA, Portenoy RK, Tennstedt SL (2008) Symptom distress and quality of life in patients with advanced congestive heart failure. J Pain Symptom Manage 35:594–603

    Article  PubMed  PubMed Central  Google Scholar 

  16. 16.

    Murray SA, Sheikh A (2008) Care for all at the end of life. BMJ 336:958–959

    Article  PubMed  PubMed Central  Google Scholar 

  17. 17.

    O’Leary N, Tiernan E (2008) Survey of specialist palliative care services for noncancer patients in Ireland and perceived barriers. Palliat Med 2008(22):77–83

    Article  Google Scholar 

  18. 18.

    Jendyk R, Maisel P (2013) Die Lehre im Fach Palliativmedizin an den medizinischen Fakultäten in Deutschland – eine Analyse des Status quo. Z Allg Med 89:276–279

    Google Scholar 

  19. 19.

    Radbruch L, Bausewein C, Simon ST, Sipp W, Wodarg W, Jünger S (2011) Europäische Empfehlungen zur Palliativversorgung und Hospizarbeit und ihre Umsetzung in Deutschland. Z Palliativmed 12:175–183

    Google Scholar 

Download references

Acknowledgements

This paper was prepared as part of the project “End of life care for frail older patients in family practice” funded by the German Federal Ministry of Education and Research (Bundesministerium für Bildung und Forschung, BMBF) under project no. 01GY1120.

Author information

Affiliations

Authors

Corresponding author

Correspondence to N. Schneider.

Ethics declarations

Conflict of interest

K. Afshar, K. Geiger, G. Müller-Mundt, J. Bleidorn and N. Schneider state that there are no conflicts of interest.

The accompanying manuscript does not include studies on humans or animals.

Additional information

English version of: Afshar K, Geiger K, Müller-Mundt G, Bleidorn J, Schneider N (2015) Hausärztliche Palliativversorgung bei nichtonkologischen Patienten. Eine Übersichtsarbeit. Schmerz 29:604–615. doi:10.1007/s00482-015-0054-9

Appendix

Appendix

Articles included

  1. e1.

    Abarshi E, Echteld MA, Donker G, Van den Block L, Onwuteaka-Philipsen B, Deliens L. Discussing end-of-life issues in the last months of life: A nationwide study among general practitioners. J Palliat Med 2011;14(3):323–30.

  2. e2. 

    Abarshi E, Echteld MA, Van den Block L, Donker G, Bossuyt N, Meeussen K, et al. Use of palliative care services and general practitioner visits at the end of life in the Netherlands and Belgium. J Pain Symptom Manage 2011;41(2):436–48.

  3. e3.

    Abarshi E, Echteld MA, Van den Block L, Donker G, Deliens L, Onwuteaka-Philipsen B. The oldest old and GP end-of-life care in the Dutch community: A nationwide study. Age Ageing 2010;39(6):716–22.

  4. e4.

    Abarshi E, Onwuteaka-Philipsen B, Donker G, Echteld M, Van den Block L, Deliens L. General practitioner awareness of preferred place of death and correlates of dying in a preferred place: A nationwide mortality follow-back study in the Netherlands. J Pain Symptom Manage 2009;38(4):568–77.

  5. e5.

    Abarshi EA, Echteld MA, Van den Block L, Donker GA, Deliens L, Onwuteaka-Philipsen BD. Recognising patients who will die in the near future: A nationwide study via the Dutch sentinel network of GPs. Br J Gen Pract 2011;61(587):e371–8.

  6. e6.

    Ahluwalia SC, Fried TR. Physician factors associated with outpatient palliative care referral. Palliat Med 2009;23(7):608–15.

  7. e7.

    Asadi-Lari M, Madjd Z, Afkari ME, Goushegir A, Baradaran HR. The concept of palliative care practice among Iranian general practitioners. Iran J Cancer Prev 2009;2(3):111–6.

  8. e8.

    Bajwah S, Higginson IJ. General practitioners’ use and experiences of palliative care services: A survey in south east England. BMC Palliat Care 2008;7:18.

  9. e9.

    Barclay S, Momen N, Case-Upton S, Kuhn I, Smith E. End-of-life care conversations with heart failure patients: A systematic literature review and narrative synthesis. Br J Gen Pract 2011;61(582):e49–62.

  10. e10.

    Barnes S, Gott M, Payne S, Parker C, Seamark D, Gariballa S, Small N. Predicting mortality among a general practice-based sample of older people with heart failure. Chronic Illn 2008;4(1):5–12.

  11. e11.

    Beccaro M, Lora Aprile P, Scaccabarozzi G, Cancian M, Costantini M. Survey of Italian general practitioners: Knowledge, opinions, and activities of palliative care. J Pain Symptom Manage 2013;46(3):335–44.

  12. e12.

    Beernaert K, Cohen J, Deliens L, Devroey D, Vanthomme K, Pardon K, et al. Referral to palliative care in COPD and other chronic diseases: A population-based study. Respir Med 2013;107(11):1731–9.

  13. e13.

    Behmann M, Jünger S, Radbruch L, Schneider N. Public health actions to improve palliative care in Germany: Results of a three-round Delphi study. Health Policy 2012;106(3):303–12.

  14. e14.

    Bloomer M, Tan H, Lee S. End of life care: The importance of advance care planning. Aust Fam Physician 2010;39(10):734–7.

  15. e15.

    Borgsteede S, Graafland-Riedstra C, Deliens L, Francke A, Van Eijk J, Willems D. Good care during the last phase of life according to patients and their family doctor. Huisarts Wet 2008;51(3):120–4.

  16. e16.

    Borgsteede SD, Deliens L, Zuurmond WWA, Schellevis FG, Willems DL, Van der Wal G, et al. Prescribing of pain medication in palliative care. A survey in general practice. Pharmacoepidemiol Drug Saf 2009;18(1):16–23.

  17. e17.

    Brueckner T, Schumacher M, Schneider N. Palliative care for older people exploring the views of doctors and nurses from different fields in Germany. BMC Palliat Care 2009;8:7.

  18. e18.

    Carrington L, Bath PA, Hughes P, Ahmed N, Noble B. Information management and quality of palliative care in general practices: Secondary analysis of a UK study. J Inf Sci 2013;39(1):126–40.

  19. e19.

    Charlton R, Currie A. A UK perspective on worldwide inadequacies in palliative care training: A short postgraduate course is proposed. Am J Hosp Palliat Care 2008;25(1):63–71.

  20. e20.

    Claessen SJJ, Echteld MA, Francke AL, Van den Block L, Donker GA, Deliens L. Important treatment aims at the end of life: A nationwide study among GPs. Br J Gen Pract 2012;62(595):e121–6.

  21. e21.

    Claessen SJJ, Francke AL, Echteld MA, Schweitzer BPM, Donker GA, Deliens L. GPs’ recognition of death in the foreseeable future and diagnosis of a fatal condition: A national survey. BMC Family Pract 2013;14:104.

  22. e22.

    Claessen SJJ, Francke AL, Engels Y, Deliens L. How do GPs identify a need for palliative care in their patients? an interview study. BMC Fam Pract 2013;14:42.

  23. e23.

    Clark K, Phillips J. End of life care: The importance of culture and ethnicity. Aust Fam Physician 2010;39(4):210–3.

  24. e24.

    Cosyns M, Deveugele M, Abbadie B, Roland M. Decision-making and end of life care. Rev Med Brux 2008;29(2):77–88.

  25. e25.

    Dale J, Petrova M, Munday D, Koistinen-Harris J, Lall R, Thomas K. A national facilitation project to improve primary palliative care: Impact of the Gold Standards Framework on process and self-ratings of quality. Qual Saf Health Care 2009;18(3):174–80.

  26. e26.

    Davidson PM, Macdonald PS, Newton PJ, Currow DC. End stage heart failure patients: Palliative care in general practice. Aust Fam Physician 2010;39(12):916–20.

  27. e27.

    Davison G, Shelby-James TM. Palliative care case conferencing involving general practice: An argument for a facilitated standard process. Aust Health Rev 2012;36(1):115–9.

  28. e28.

    De Bock GH, Van Kampen IM, Van der Goot JH, Hamstra M, Dekker JH, Schuit KW, et al. Transfer of information on palliative home care during the out-of-hours period. Fam Pract 2011;28(3):280–6.

  29. e29.

    De Korte-Verhoef MC, Pasman HRW, Schweitzer BP, Francke AL, Onwuteaka-Philipsen BD, Deliens L. End-of-life hospital referrals by out-of-hours general practitioners: A retrospective chart study. BMC Fam Pract 2012;13:89.

  30. e30.

    Dean MM. End-of-life care for COPD patients. Prim Care Respir J 2008;17(1):46–50.

  31. e31.

    DeMiglio L, Williams A. Factors enabling shared care with primary healthcare providers in community settings: The experiences of interdisciplinary palliative care teams. J Palliat Care 2012;28(4):282–9.

  32. e32.

    Evans G. Improving end of life care for the person with dementia: A practical approach from general practice. Dementia 2009;8(3):363–76.

  33. e33.

    Evans N, Costantini M, Pasman HR, Van den Block L, Donker GA, Miccinesi G, Bertolissi S, Gil M, Boffin N, Zurriaga O, et al. End-of-life communication: A retrospective survey of representative general practitioner networks in four countries. J Pain Symptom Manage 2014;47(3):604–619. Epub 2013 Aug 7.

  34. e34.

    Evans N, Pasman HR, Vega Alonso T, Van den Block L, Miccinesi G, Van Casteren V, Donker G, Bertolissi S, Zurriaga O, Deliens L, et al. End-of-life decisions: A cross-national study of treatment preference discussions and surrogate decision-maker appointments. Plos One 2013;8(3):e57965. Epub 2013 Mar 5.

  35. e35.

    Foreva G. Family physician’s role in palliative care. General Medicine 2009;11(2):18–24.

  36. e36.

    Foreva G, Asenova R, Despotova-Toleva L. General practitioner’s view on palliative care providing: A pilot study. General Medicine 2010;12(1):3–7.

  37. e37.

    Foreva G, Despotova-Toleva L, Asenova R, Semerjieva M. Defining patients in need of palliative care in general practice setting. General Medicine 2010;12(4):3–8.

  38. e38.

    Fougère B, Mytych I, Baudemont C, Gautier-Roques E, Montaz L. Management of patients in pain in palliative care by general practitioners (GPs). Médecine Palliative 2012;11(2):90–7.

  39. e39.

    Frey R, Gott M, Banfield R. What indicators are measured by tools designed to address palliative care competence among ‘generalist’ palliative care providers? A critical literature review. Prog Palliat Care 2011;19(3):114–24.

  40. e40.

    Gágyor I, Lüthke A, Jansky M, Chenot JF. End of life care in general practice: Results of an observational survey with general practitioners. Schmerz 2013;27(3):289–95.

  41. e41.

    Gardiner C, Gott M, Ingleton C. Factors supporting good partnership working between generalist and specialist palliative care services: A systematic review. Br J Gen Pract 2012;62(598):e353–62.

  42. e42.

    Gardiner C, Gott M, Ingleton C, Hughes P, Winslow M, Bennett MI. Attitudes of health care professionals to opioid prescribing in end-of-life care: A qualitative focus group study. J Pain Symptom Manage 2012;44(2):206–14.

  43. e43.

    Giesen P, Veldhoven C, Vlaar N, Borghuis M, Koetsenruijter J, Verheggen S. Patients’ opinion of weekend cover by palliative care general practitioners. Huisarts Wet 2011;54(12):646–9.

  44. e44.

    Glare P, Clark K. Management of a patient with terminal illness: The final stages of life. Medicine Today 2008;9(6):40–8.

  45. e45.

    Gorlén T, Gorlén TF, Vass M, Neergaard MA. Low confidence among general practitioners in end-of-life care and subcutaneous administration of medicine. Dan Med J 2012;59(4):A4407.

  46. e46.

    Hall S, Murchie P, Campbell C, Murray SA. Introducing an electronic palliative care summary (ePCS) in Scotland: Patient, carer and professional perspectives. Fam Pract 2012;29(5):576–85.

  47. e47.

    Handley M, Goodman C, Froggatt K, Mathie E, Gage H, Manthorpe J, Barclay S, Crang C, Iliffe S. Living and dying: Responsibility for end-of-life care in care homes without on-site nursing provision – a prospective study. Health Soc Care Community 2014;22(1):22–9. Epub 2013 May 29.

  48. e48.

    Harringer W. Advance directives in general practice. Ther Umsch 2012;69(2):107–9.

  49. e49.

    Harrison N, Cavers D, Campbell C, Murray SA. Are UK primary care teams formally identifying patients for palliative care before they die? Br J Gen Pract 2012;62(598):e344–52

  50. e50.

    Hawley P, Liebscher R, Wilford J. Continuing methadone for pain in palliative care. Pain Res Manag 2013;18(2):83–6.

  51. e51.

    Highet G, Crawford D, Murray SA, Boyd K. Development and evaluation of the Supportive and Palliative Care Indicators Tool (SPICT): a mixed-methods study. BMJ Support Palliat Care 2014;4(3):285–90. Epub 2013 Jul 25.

  52. e52.

    Hoexum M, Bosveld HEP, Schuling J, Berendsen AJ. Out-of-hours medical care for terminally ill patients: A survey of availability and preferences of general practitioners. Palliat Med 2012;26(8):986–93.

  53. e53.

    Hong TC, Lam TP, Chao DVK. Barriers facing family physicians providing palliative care service in Hong Kong – A questionnaire survey. Hong Kong Practitioner 2013;35(2):36–51.

  54. e54.

    Hong TC, Lam TP, Chao DVK. Barriers for primary care physicians in providing palliative care service in Hong Kong – qualitative study. Hong Kong Practitioner 2010;32(1):3–9.

  55. e55.

    Johnson A, Chang E, Daly J, Harrison K, Noel M, Hancock K, Easterbrook S. The communication challenges faced in adopting a palliative care approach in advanced dementia. Int J Nurs Pract 2009;15(5):467–74.

  56. e56.

    Johnson CE, Mitchell G, Thomas K. The potential for a structured approach to palliative and end of life care in the community in Australia. Australas Med J 2010;3(6):313–7.

  57. e57.

    Kelly B, Varghese FT, Burnett P, Turner J, Robertson M, Kelly P, Mitchell G, Treston P. General practitioners’ experiences of the psychological aspects in the care of a dying patient. Palliat Support Care 2008;6(2):125–31.

  58. e58.

    Ko DN, Perez-Cruz P, Blinderman CD. Ethical issues in palliative care. Prim Care 2011;38(2):183–93.

  59. e59.

    Law D. Primary and secondary care collaboration for end of life care. London J Prim Care (Abingdon) 2009(2):107–12.

  60. e60.

    Lawrenson R, Smyth D, Kara E, Thomson R. Rural general practitioner perspectives of the needs of Maori patients requiring palliative care. N Z Med J 2010;123(1315):30–6.

  61. e61.

    Leemans K, Van den Block L, Bilsen J, Cohen J, Boffin N, Deliens L. Dying at home in Belgium: A descriptive GP interview study. BMC Fam Pract 2012;13:4.

  62. e62.

    Linklater G, Lawton S, Macaulay L, Carroll D. Palliative patients with pain: Why the family physician phones a specialist advice line. Int J Disabil Hum Dev 2009;8(1):21–4.

  63. e63.

    Lucey M, McQuillan R, MacCallion A, Corrigan M, Flynn J, Connaire K. Access to medications in the community by patients in a palliative setting. A systems analysis. Palliat Med 2008;22(2):185–9.

  64. e64.

    Mahmood-Yousuf K, Munday D, King N, Dale J. Interprofessional relationships and communication in primary palliative care: Impact of the Gold Standards Framework. Br J Gen Pract 2008;58(549):256–63.

  65. e65.

    Marrilliet A, Ruhlmann C, Laval G, Labarère J. The need of a palliative care hotline for general practitioners in Isère. Médecine Palliative 2013;12(1):32–41.

  66. e66.

    Marshall D, Howell D, Brazil K, Howard M, Taniguchi A. 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.e7.

  67. e67.

    Mason B, Epiphaniou E, Nanton V, Donaldson A, Shipman C, Daveson BA, et al. Coordination of care for individuals with advanced progressive conditions: A multi-site ethnographic and serial interview study. Br J Gen Pract 2013;63(613):e580–8.

  68. e68.

    Masso M, Owen A. Linkage, coordination and integration: Evidence from rural palliative care. Aust J Rural Health 2009;17(5):263–7.

  69. e69.

    Mathie E, Goodman C, Crang C, Froggatt K, Iliffe S, Manthorpe J, et al. An uncertain future: The unchanging views of care home residents about living and dying. Palliat Med 2012;26(5):734–43.

  70. e70.

    Mattiussi M, Dawidowski A, Restibo J, Pollán J, Pezzano L, Cámera L. Physicians’ views and perspectives on advanced directives in patients with incipient dementia. Medicina (Argentina) 2012;72(4):305–14.

  71. e71.

    McCormick E, Chai E, Meier DE. Integrating palliative care into primary care. Mt Sinai J Med 2012;79(5):579–85.

  72. e72.

    McKechnie R, MacLeod R, Jaye C. Palliative care for people with non-malignant conditions in a New Zealand community. Prog Palliat Care 2010;18(5):275–80.

  73. e73.

    Meeussen K, Van den Block L, Bossuyt N, Bilsen J, Echteld M, Van Casteren V, et al. GPs’ awareness of patients’ preference for place of death. Br J Gen Pract 2009;59(566):665–70.

  74. e74.

    Meeussen K, Van den Block L, Echteld M, Boffin N, Bilsen J, Van Casteren V, Deliens L. Older people dying with dementia: A nationwide study. Int Psychogeriatr 2012;24(10):1581–91. Epub 2012 May 30.

  75. e75.

    Meeussen K, Van den Block L, Echteld M, Bossuyt N, Bilsen J, Van Casteren V, et al. Advance care planning in Belgium and the Netherlands: A nationwide retrospective study via sentinel networks of general practitioners. J Pain Symptom Manage 2011;42(4):565–77.

  76. e76.

    Michiels E, Deschepper R, Bilsen J, Mortier F, Deliens L. Information disclosure to terminally ill patients and their relatives: Self-reported practice of Belgian clinical specialists and general practitioners. Palliat Med 2009;23(4):345–53.

  77. e77.

    Minto F, Strickland K. Anticipating emotion: A qualitative study of advance care planning in the community setting. Int J Palliat Nurs 2011;17(6):278–84.

  78. e78.

    Mitchell GK, Del Mar CB, O’Rourke PK, Clavarino AM. Do case conferences between general practitioners and specialist palliative care services improve quality of life? A randomised controlled trial (ISRCTN 52269003). Palliat Med 2008;22(8):904–12.

  79. e79.

    Mitchell GK, Johnson CE, Thomas K, Murray SA. Palliative care beyond that for cancer in Australia. Med J Aust 2010;193(2):124–6.

  80. e80.

    Murray SA, Osman H. Primary palliative care: The potential of primary care physicians as providers of palliative care in the community in the eastern Mediterranean region. East Mediterr Health J 2012;18(2):178–83.

  81. e81.

    Ng CG, Dijkstra E, Smeets H, Boks MPM, De Wit NJ. Psychiatric comorbidity among terminally ill patients in general practice in the Netherlands: A comparison between patients with cancer and heart failure. Br J Gen Pract 2013;63(606):e63–8

  82. e82.

    Phillips J, Davidson PM, Willcock S. An insight into the delivery of a palliative approach in residential aged care: The general practitioner perspective. J Appl Gerontol 2009;28(3):395–405.

  83. e83.

    Pype P, Stes A, Wens J, Van den Eynden B, Deveugele M. The landscape of postgraduate education in palliative care for general practitioners: Results of a nationwide survey in Flanders, Belgium. Patient Educ Couns 2012;86(2):220–5.

  84. e84.

    Pype P, Symons L, Wens J, Van den Eynden B, Stess A, Cherry G, et al. Healthcare professionals’ perceptions toward interprofessional collaboration in palliative home care: A view from Belgium. J Interprof Care 2013;27(4):313–9. Epub 2012 Nov 27.

  85. e85.

    Pype P, Wens J, Deveugele M, Stes A, Van den Eynden B. Postgraduate education on palliative care for general practitioners in Belgium. Palliat Med 2011;25(2):187–8.

  86. e86.

    Pype P, Wens J, Stes A, Deveugele M, Van den Eynden B. Continuing education of general practitioners in Flanders (Belgium) concerning palliative care: An audit of the registration system. Ned Tijdschr Geneeskd 2012;68(3):109–15.

  87. e87.

    Rhee JJ, Zwar NA, Kemp LA. Advance care planning and interpersonal relationships: A two-way street. Fam Pract 2013;30(2):219–26.

  88. e88.

    Rhee JJ, Zwar NA, Vagholkar S, Dennis S, Broadbent AM, Mitchell G. Attitudes and barriers to involvement in palliative care by Australian urban general practitioners. J Palliat Med 2008;11(7):980–5.

  89. e89.

    Rutten FH, Heddema WS, Daggelders GJA, Hoes AW. Primary care patients with heart failure in the last year of their life. Fam Pract 2012;29(1):36–42.

  90. e90.

    Sanderson C, Tieman J. CareSearch, online palliative care information for GPs. Aust Fam Physician 2010;39(5):341–3.

  91. e91.

    Schneider N, Engeser P, Behmann M, Kühne F, Wiese B. Specialized outpatient palliative care. The expectations of general practitioners. Schmerz 2011;25(2):166–73.

  92. e92.

    Schneider N, Mitchell G, Murray SA. Outpatient palliative care: The general practitioner as the first contact person. Dtsch Arztebl 2010;107(19):A925–7.

  93. e93.

    Schubert I, Heymans L, Fessler J. General practitioners’ guideline for palliative care. A survey of guideline acceptance in quality circles of primary medical care. Med Klin 2010;105(3):135–41.

  94. e94.

    Schweitzer B, Blankenstein N, Deliens L, van der Horst H. Out-of-hours palliative care provided by GP co-operatives in the Netherlands: A focus group study. Eur J Gen Pract 2011;17(3):160–6. Epub 2011 May 16.

  95. e95.

    Schweitzer B, Blankenstein N, Deliens L, van der Horst H. Transfers of palliative care to the general practitioner’s station. Huisarts Wet 2011;54(8):422–6.

  96. e96.

    Schweitzer BP, Blankenstein N, Deliens L, van der Horst H. Out-of-hours palliative care provided by GP co-operatives: Availability, content and effect of transferred information. BMC Palliat Care 2009;8:17.

  97. e97.

    Serresse L. General practitioner and terminally ill patient: To identify stressors in their palliative care practice and how to deal with those difficulties. Médecine Palliative 2011;10(6):286–91.

  98. e98.

    Shah AB, Morrissey RP, Baraghoush A, Bharadwaj P, Phan A, Hamilton M, et al. Failing the failing heart: A review of palliative care in heart failure. Rev Cardiovasc Med 2013;14(1):41–8.

  99. e99.

    Shaw KL, Clifford C, Thomas K, Meehan H. Improving end-of-life care: A critical review of the Gold Standards Framework in primary care. Palliat Med 2010;24(3):317–29.

  100. e100.

    Shipman C, Gysels M, White P, Worth A, Murray SA, Barclay S, et al. Improving generalist end of life care: National consultation with practitioners, commissioners, academics, and service user groups. BMJ 2008;337:a1720.

  101. e101.

    Shipman C, White S, Gysels M, White P. Access to care in advanced COPD: Factors that influence contact with general practice services. Prim Care Respir J 2009;18(4):273–8.

  102. e102.

    Slort W, Blankenstein AH, Deliens L, van der Horst HE. Facilitators and barriers for GP-patient communication in palliative care: A qualitative study among GPs, patients, and end-of-life consultants. Br J Gen Pract 2011;61(585):167–72

  103. e103.

    Slort W, Blankenstein AH, Schweitzer BP, Knol DL, Deliens L, Aaronson NK, van der Horst HE. Effectiveness of the ACA (Availability, Current issues and Anticipation) training programme on GP-patient communication in palliative care; A controlled trial. BMC Fam Pract 2013;14:93.

  104. e104.

    Slort W, Blankenstein AH, Wanrooij BS, Van Der Horst HE, Deliens L. The ACA training programme to improve communication between general practitioners and their palliative care patients: Development and applicability. BMC Palliat Care 2012;11:9.

  105. e105.

    Slort W, Pype P, Deveugele M. Communication in the palliative phase. Huisarts Wet 2011;54(11):614–7.

  106. e106.

    Slort W, Schweitzer BPM, Blankenstein AH, Abarshi EA, Riphagen I, Echteld MA, Aaronson NK, Van Der Horst HE, Deliens L. Perceived barriers and facilitators for general practitioner-patient communication in palliative care: A systematic review. Palliat Med 2011;25(6):613–29.

  107. e107.

    Smyth D, Farnell A, Dutu G, Lillis S, Lawrenson R. Palliative care provision by rural general practitioners in New Zealand. J Palliat Med 2010;13(3):247–50.

  108. e108.

    Tan A, Manca D. Finding common ground to achieve a “good death”: Family physicians working with substitute decision-makers of dying patients. A qualitative grounded theory study. BMC Fam Pract 2013;14:14

  109. e109.

    Tan HM, Oconnor MM, Miles G, Klein B, Schattner P. GP and nurses’ perceptions of how after hours care for people receiving palliative care at home could be improved: A mixed methods study. BMC Palliat Care 2009;8:13.

  110. e110.

    Taubert M, Nelson A. Oh god, not a palliative: Out-of-hours general practitioners within the domain of palliative care. Palliat Med 2010;24(5):501–9.

  111. e111.

    Taubert M, Nelson A. Out-of-hours GPs and palliative care-a qualitative study exploring information exchange and communication issues. BMC Palliat Care 2010;9:18.

  112. e112.

    Texier G, Rhondali W, Morel V, Filbet M. Care refusal of the patient in palliative care (in terminal phase) at home by general practitioner: Is it a reality? Médecine Palliative 2013;12(2):55–62.

  113. e113.

    Thomas P. Inter-organisation communication for end of life care. London J Prim Care (Abingdon) 2009;2(2):118–24.

  114. e114.

    Thoonsen B, Engels Y, Van Rijswijk E, Verhagen S, Van Weel C, Groot M, et al. Early identification of palliative care patients in general practice: Development of RADboud indicators for PAlliative Care needs (RADPAC). Br J Gen Pract 2012;62(602):e625–31.

  115. e115.

    Tieman JJ. Filters and hubs: Shortening the distance to palliative care evidence. Aust J Prim Health 2012;18(4):268–73.

  116. e116.

    Toye C, Blackwell S, Maher S, Currow DC, Holloway K, Tieman J, et al. Guidelines for a palliative approach for aged care in the community setting: A suite of resources. Australas Med J 2012;5(11):569–74. Epub 2012 Nov 30.

  117. e117.

    Van den Block L, Onwuteaka-Philipsen B, Meeussen K, Donker G, Giusti F, Miccinesi G, et al. Nationwide continuous monitoring of end-of-life care via representative networks of general practitioners in Europe. BMC Fam Pract 2013;14:73.

  118. e118.

    Vega T, Arrieta E, Lozano JE, Miralles M, Anes Y, Gomez C, et al. Palliative and support care at home in primary care. Gaceta Sanitaria 2011;25(3):205–10.

  119. e119.

    Walshe C, Caress A, Chew-Graham C, Todd C. Implementation and impact of the Gold Standards Framework in community palliative care: A qualitative study of three primary care trusts. Palliat Med 2008;22(6):736–43.

  120. e120.

    Walshe C, Told C, Cares A, Chew-Graham C. Judgements about fellow professionals and the management of patients receiving palliative care in primary care: A qualitative study. Br J Gen Pract 2008;58(549):264–72.

  121. e121.

    Warmenhoven F, van Rijswijk E, van Hoogstraten E, van Spaendonck K, Lucassen P, Prins J, et al. How family physicians address diagnosis and management of depression in palliative care patients. Ann Fam Med 2012;10(4):330–6

  122. e122.

    Waterworth S, Raphael D, Horsburgh M. Yes, but it’s somewhat difficult-managing end of life care in primary health care. Ageing Int 2012;37(4):459–69.

  123. e123.

    White P, White S, Edmonds P, Gysels M, Moxham J, Seed P, et al. Palliative care or end-of-life care in advanced chronic obstructive pulmonary disease: A prospective community survey. Br J Gen Pract 2011;61(587):e362–70.

  124. e124.

    Wiese CHR, Duttge G, Taghavi M, Lassen CL, Meyer N, Andreesen R, Graf BM, et al. Preventive crisis management in general outpatient palliative care – prospectively cross-sectional study of general practitioners in eastern Bavaria. Dtsch Med Wochenschr 2011;136(45):2302–7. Epub 2011 Nov 2.

  125. e125.

    Xhixha A, Rama R, Radbruch L. Reducing the barriers to pain management in Albania: Results from an educational seminar with family doctors. J Palliat Med 2013;16(7):758–61.

  126. e126.

    Yohannes AM. Palliative care and management principles in older patients with advanced chronic obstructive pulmonary disease. Aging Health 2011;7(3):409–21.

  127. e127.

    Young J, Donahue M, Farquhar M, Simpson C, Rocker G. Using opioids to treat dyspnea in advanced COPD: Attitudes and experiences of family physicians and respiratory therapists. Can Fam Physician 2012;58(7):e401–7.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Afshar, K., Geiger, K., Müller-Mundt, G. et al. Generalist palliative care for non-cancer patients. Schmerz (2016). https://doi.org/10.1007/s00482-016-0135-4

Download citation

Keywords

  • Palliative care
  • End-of-life care
  • Family medicine
  • General practice
  • Treatment

Schlüsselwörter

  • Lebensende
  • Palliativmedizin
  • Familienmedizin
  • Hausarzt
  • Versorgung