title: Many people in Scotland now benefit from anticipatory care before they die: an after death analysis and interviews with general practitioners.
abstract: BACKGROUND
  Key Information Summaries (KIS) were introduced throughout Scotland in 2013 so that anticipatory care plans written by general practitioners (GPs) could be routinely shared electronically and updated in real time, between GPs and providers of unscheduled and secondary care.
  
  
  OBJECTIVE
  We aimed to describe the current reach of anticipatory and palliative care, and to explore GPs' views on using KIS.
  
  
  METHODS
  We studied the primary care records of all patients who died in 2014 in 9 diverse Lothian practices. We identified if anticipatory or palliative care had been started, and if so how many weeks before death and which aspects of care had been documented. We interviewed 10 GPs to understand barriers and facilitating factors.
  
  
  RESULTS
  Overall, 60% of patients were identified for a KIS, a median of 18 weeks before death. The numbers identified were highest for patients with cancer, with 75% identified compared with 66% of those dying with dementia/frailty and only 41% dying from organ failure. Patients were more likely to die outside hospital if they had a KIS. GPs identified professional, patient and societal challenges in identifying patients for palliative care, especially those with non-cancer diagnoses.
  
  
  CONCLUSIONS
  GPs are identifying patients for anticipatory and palliative care more equitably across the different disease trajectories and earlier in the disease process than they were previously identifying patients specifically for palliative care. However, many patients still lack care planning, particularly those dying with organ failure.
authors.affiliation: Primary Palliative Care Research Group, Centre for Population Health Sciences, The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK.
authors.forename: Julia
authors.initials: J
authors.lastname: Tapsfield
authors.affiliation: Marie Curie Hospice Edinburgh, Edinburgh, UK.
authors.forename: Charlie
authors.initials: C
authors.lastname: Hall
authors.affiliation: NHS Lothian, Edinburgh, UK.
authors.forename: Carey
authors.initials: C
authors.lastname: Lunan
authors.affiliation: NHS Lothian, Edinburgh, UK.
authors.forename: Hazel
authors.initials: H
authors.lastname: McCutcheon
authors.affiliation: Department in Strategic Planning and Modernisation, Lothian NHS Board, Edinburgh, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: McLoughlin
authors.affiliation: School of Public Health & Community Medicine, The University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Joel
authors.initials: J
authors.lastname: Rhee
authors.affiliation: Primary Care Research Unit of Mallorca, Baleares Health Services-IbSalut, Palma, Spain.|Instituto de Investigación Sanitaria de Palma, Palma, Spain.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Leiva
authors.affiliation: Marie Curie Hospice Edinburgh, Edinburgh, UK.
authors.forename: Juliet
authors.initials: J
authors.lastname: Spiller
authors.affiliation: Marie Curie Hospice Edinburgh, Edinburgh, UK.
authors.forename: Anne
authors.initials: A
authors.lastname: Finucane
authors.affiliation: Primary Palliative Care Research Group, Centre for Population Health Sciences, The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK.
authors.forename: Scott A
authors.initials: SA
authors.lastname: Murray
mesh_terms: D000328:Adult; D000368:Aged; D003704:Dementia / Q000628:therapy; D005260:Female; D058005:General Practitioners / Q000523:psychology / Q000706:statistics & numerical data*; D006801:Humans; D033181:Information Dissemination; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy; D010166:Palliative Care / Q000523:psychology / Q000706:statistics & numerical data*; D010347:Patient Care Planning / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012606:Scotland; D013727:Terminal Care / Q000706:statistics & numerical data*
keywords: Chronic conditions; Home care; Service evaluation; Supportive care; Terminal care