title: Timely identification of palliative patients and anticipatory care planning by GPs: practical application of tools and a training programme.
abstract: BACKGROUND
  Palliative care is mainly restricted to terminal care. General practitioners (GPs) are not trained to early identify palliative patients with cancer, COPD or heart failure. With the help of the RADboud indicators for PAlliative Care needs (RADPAC), we trained GPs to identify patients' needs and to make a proactive care plan. They were also able to join two role-plays where they discussed the patient's future, and consulted a palliative care consultant to fine-tune the care plan. We evaluated the programme with the GPs and consultants and noted its impact on their daily practice.
  
  
  METHODS
  Two years after they had participated in the programme, we held semi-structured interviews with the GPs and a focus group interview with the consultants and performed a thematic content analysis.
  
  
  RESULTS
  Six consultants and nine GPs participated in the programme. Most GPs and consultants mentioned positive changes in the thinking or acting of GPs regarding early palliative care. A number continued to use the tool to identify patients; most of the others noted they had internalised the indicators. Although half of them still considered discussing end-of-life aspects difficult, particularly in patients with organ failure, the others were more easily able to discuss the future with their palliative patients.
  
  
  CONCLUSIONS
  Although most GPs and consultants were positive about the training programme and applying it in daily practice, we conclude that in future programmes, more attention needs to paid to timely identification of palliative patients with COPD or CHF and how to discuss the future with them.
authors.affiliation: Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Bregje
authors.initials: B
authors.lastname: Thoonsen
authors.affiliation: Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Marieke
authors.initials: M
authors.lastname: Groot
authors.affiliation: Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Stans
authors.initials: S
authors.lastname: Verhagen
authors.affiliation: Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.|Department of Health Services Research and Quality, Australian National University, Canberra, Australia.
authors.forename: Chris
authors.initials: C
authors.lastname: van Weel
authors.affiliation: Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Kris
authors.initials: K
authors.lastname: Vissers
authors.affiliation: Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands. yvonne.engels@radboudumc.nl.|Radboud University Medical Center, Post box 9101, Internal code 549, 6500 HB, Nijmegen, The Netherlands. yvonne.engels@radboudumc.nl.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Engels
mesh_terms: D000328:Adult; D004493:Education / Q000592:standards; D005260:Female; D017144:Focus Groups; D058005:General Practitioners / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010166:Palliative Care / Q000379:methods*; D010347:Patient Care Planning; D010355:Patient Identification Systems / Q000379:methods*; D012017:Referral and Consultation
keywords: Anticipatory; CHF; COPD; Cancer; General practitioner; Identification; Timely palliative care; Training