Role and response of primary healthcare services in community end-of-life care during COVID-19: Qualitative study and recommendations for primary palliative care delivery

Turner, Nicola; Wahid, Aysha; Oliver, Phillip; Gardiner, Clare; Chapman, Helen; Khan, Dena; Boyd, Kirsty; Dale, Jeremy; Barclay, Stephen; Mayland, Catriona R.; Mitchell, Sarah J.

Abstract

Background: The need for end-of-life care in the community increased significantly during the COVID-19 pandemic. Primary care services, including general practitioners and community nurses, had a critical role in providing such care, rapidly changing their working practices to meet demand. Little is known about primary care responses to a major change in place of care towards the end of life, or the implications for future end-of-life care services. Aim: To gather general practitioner and community nurse perspectives on factors that facilitated community end-of-life care during the COVID-19 pandemic, and to use this to develop recommendations to improve future delivery of end-of-life care. Design: Qualitative interview study with thematic analysis, followed by refinement of themes and recommendations in consultation with an expert advisory group. Participants: General practitioners (n = 8) and community nurses (n = 17) working in primary care in the UK. Results: General practitioner and community nurse perspectives on factors critical to sustaining community end-of-life care were identified under three themes: (1) partnership working is key, (2) care planning for end-of-life needs improvement, and (3) importance of the physical presence of primary care professionals. Drawing on participants’ experiences and behaviour change theory, recommendations are proposed to improve end-of-life care in primary care. Conclusions: To sustain and embed positive change, an increased policy focus on primary care in end-of-life care is required. Targeted interventions developed during COVID-19, including online team meetings and education, new prescribing systems and unified guidance, could increase capacity and capability of the primary care workforce to deliver community end-of-life care.

• Journal Article Type: Article
• Acceptance Date: Oct 31, 2022
• Online Publication Date: Dec 3, 2022
• Publication Date: 2023-02
• Deposit Date: Dec 12, 2022
• Publicly Available Date: Jan 3, 2023
• Journal: Palliative Medicine
• Electronic ISSN: 1477-030X
• Publisher: SAGE Publications
• Peer Reviewed: Peer Reviewed
• Volume: 37
• Issue: 2
• Pages: 235-243
• DOI: https://doi.org/10.1177/02692163221140435
• Public URL: https://nottingham-repository.worktribe.com/output/14602557
• Publisher URL: https://journals.sagepub.com/doi/10.1177/02692163221140435