title: Are UK primary care teams formally identifying patients for palliative care before they die?
abstract: BACKGROUND
  The palliative care approach has the potential to improve care for patients with progressive life-threatening illnesses from the time of diagnosis. Policy and clinical directives in the UK advocate early identification.
  
  
  OBJECTIVE
  To determine the extent to which practices identify patients for palliative care, including factors influencing early identification and possible effects on place of death.
  
  
  METHODS
  Qualitative and quantitative data were collected from six general practices from three Scottish NHS boards and analysed.
  
  
  METHODS
  Records of patients who had died in the previous 6 months were analysed and interviews with practice staff (n = 21) and with patients currently on the practice palliative care register and bereaved relatives (n = 14) were conducted. In addition, a practice meeting was observed.
  
  
  RESULTS
  In total, 29% of patients who died were recorded as being on the practice palliative care register before death. Two-thirds of patients with cancer were recorded on the register, but for those with non-malignant conditions only around 20% had any palliative care documented. This was a result of GPs not finding the current guidelines useful and being reluctant to discuss palliative care overtly with patients early in their illness. Palliative care services and documentation were geared towards patients with cancer. More district nurses than GPs saw the benefits of inclusion on the palliative care register. Only 25% of patients on the register died in hospital.
  
  
  CONCLUSIONS
  Most patients with advanced progressive illnesses, especially those with non-malignant disease, are not being formally identified for a palliative care approach before they die. Those identified are more likely to benefit from coordinated care and may be more likely to die at home.
authors.affiliation: Primary Palliative Care Research Group, Centre for Population Health Sciences, University of Edinburgh, UK.
authors.forename: Nadine
authors.initials: N
authors.lastname: Harrison
authors.forename: Debbie
authors.initials: D
authors.lastname: Cavers
authors.forename: Christine
authors.initials: C
authors.lastname: Campbell
authors.forename: Scott A
authors.initials: SA
authors.lastname: Murray
mesh_terms: D000368:Aged; D002423:Cause of Death; D002908:Chronic Disease / Q000628:therapy; D002983:Clinical Competence / Q000592:standards*; D003645:Death, Sudden; D003704:Dementia / Q000628:therapy; D016330:Frail Elderly; D058006:General Practice / Q000592:standards*; D006801:Humans; D020380:Needs Assessment; D009369:Neoplasms / Q000628:therapy; D010166:Palliative Care / Q000592:standards* / Q000706:statistics & numerical data; D012042:Registries; D012606:Scotland; D013727:Terminal Care; D019452:Terminally Ill / Q000706:statistics & numerical data