Where do general practitioners find patients with possible palliative care needs?

Abstract

Background: For general practitioners (GPs) to implement early palliative care, the first step is to identify patients with palliative care needs, e.g. with a no-response to the Surprise Question (SQ) (not surprised if a patient would die within a year). Aim: To describe setting-specific screening results of patients eligible for early palliative care in family practices, here defined as patients aged 45 years with a GPs’ no-answer to the SQ. Design and setting: Secondary analysis. Cross-sectional descriptive study in family practices in 5 Belgian areas. Methods: GPs were recruited by targeted sampling. As a first part of an implementation research project, participating GPs provided demographic information about themselves and also provided a response to the SQ for all patients who came to the practice in ten consecutive office days. A summary table describing the gender, age, location of contact (surgery, patient’s home, or nursing home) of the patients was provided by each GP. Results: 56 GPs provided complete data for the practice summary tables. In total 9,150 patients were described (all ages, all settings), of which 506 patients (6%) had a SQ-no-as-answer. The distribution of SQ-no-as-answer patients per setting was 152/7659 (2%) patients seen in family practice surgeries, 139/998 (14%) patients seen in their homes, and 215/493 (44%) patients seen innursing homes. Conclusions: There was quite a large number of SQ-no-as-answer patients, with possible palliative care needs. To enhance implementation of early palliative care, future research should compare results of SQ and other screening tools with palliative care symptoms assessments.