Case conferencing for palliative care patients – a survey of South Australian general practitioners
Timothy H. M. To A B H , Paul Tait A C , Deidre D. Morgan C , Jennifer J. Tieman C , Gregory Crawford D E , Alexandra Michelmore F , David C. Currow G and Kate Swetenham A CA Southern Adelaide Palliative Services, Department of Rehabilitation, Aged Care and Palliative Care, Repatriation General Hospital, Daws Road, Daw Park, SA 5041, Australia.
B Discipline of Medicine, College of Medicine & Public Health, Flinders University, Sturt Road, Bedford Park, SA 5042, Australia.
C Discipline of Palliative and Supportive Services, College of Nursing and Health Sciences, Flinders University, Sturt Road, Bedford Park, SA 5042, Australia.
D Discipline of Medicine, Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, North Terrace, Adelaide, SA 5005, Australia.
E Northern Adelaide Palliative Care Service, Modbury Hospital, Smart Road, Modbury SA 5092, Australia.
F Clinical Planning Division, Palliative Care Clinical Network, Adelaide, SA 0000, Australia.
G ImPaCCT (Improving Palliative Care through Clinical Trials and Research), Faculty of Health, University of Technology Sydney, Ultimo, NSW 2007, Australia.
H Corresponding author. Email: timothy.to@sa.gov.au
Australian Journal of Primary Health 23(5) 458-463 https://doi.org/10.1071/PY16001
Submitted: 7 January 2016 Accepted: 15 June 2017 Published: 26 September 2017
Abstract
Benefits of case conferencing for people with palliative care needs between a general practitioner, the person and other key participants include improving communication, advance care planning, coordination of care, clarifying goals of care and support for patient, families and carers. Despite a growing evidence base for the benefits, the uptake of case conferencing has been limited in South Australia. The aim of this study is to explore the beliefs and practice of South Australian general practitioners towards case conferencing for people with palliative care needs. Using an online survey, participants were asked about demographics, attitudes towards case conferencing and details about their most recent case conference for a person with palliative care needs. Responses were received from 134 general practitioners (response rate 11%). In total, 80% valued case conferencing for people with palliative care needs; however, <25% had been involved in case conferencing in the previous 2 years. The major barrier was time to organise and coordinate case conferences. Enablers included general practitioner willingness or interest, strong relationship with patient, specialist palliative care involvement and assistance with organisation. Despite GPs’ beliefs of the benefits of case conferencing, the barriers remain significant. Enabling case conferencing will require support for organisation of case conferences and review of Medicare Benefits Schedule criteria for reimbursement.
Additional keywords: case conference, family meeting, patient care team, primary health care.
References
Abernethy AP, Currow DC, Shelby-James T, Rowett D, May F, Samsa GP, Hunt R, Williams H, Esterman A, Phillips PA (2013) Delivery strategies to optimize resource utilization and performance status for patients with advanced life-limiting illness: results from the ‘palliative care trial’ Journal of Pain and Symptom Management 45, 488–505.| Delivery strategies to optimize resource utilization and performance status for patients with advanced life-limiting illness: results from the ‘palliative care trial’Crossref | GoogleScholarGoogle Scholar |
Bajwah S, Ross JR, Wells AU, Mohammed K, Oyebode C, Birring SS, Patel AS, Koffman J, Higginson IJ, Riley J (2015) Palliative care for patients with advanced fibrotic lung disease: a randomised controlled phase II and feasibility trial of a community case conference intervention. Thorax 70, 830–839.
| Palliative care for patients with advanced fibrotic lung disease: a randomised controlled phase II and feasibility trial of a community case conference intervention.Crossref | GoogleScholarGoogle Scholar |
Cahill PJ, Lobb EA, Sanderson C, Phillips JL (2017) What is the evidence for conducting palliative care family meetings? A systematic review. Palliative Medicine 31, 197–211.
| What is the evidence for conducting palliative care family meetings? A systematic review.Crossref | GoogleScholarGoogle Scholar |
Currow DC, Abernethy AP, Fazekas BS (2004) Specialist palliative care needs of whole populations: a feasibility study using a novel approach. Palliative Medicine 18, 239–247.
| Specialist palliative care needs of whole populations: a feasibility study using a novel approach.Crossref | GoogleScholarGoogle Scholar |
Davison G, Shelby-James TM (2012) Palliative care case conferencing involving general practice: an argument for a facilitated standard process. Australian Health Review 36, 115–119.
| Palliative care case conferencing involving general practice: an argument for a facilitated standard process.Crossref | GoogleScholarGoogle Scholar |
Department of Health (2016a) Multidisciplinary case conferences. Available at http://www.health.gov.au/internet/main/publishing.nsf/Content/mbsprimarycare-caseconf-factsheet.htm [Verified 24 September 2016]
Department of Health (2016b) Residential Aged Care Palliative Approach Toolkit. Available at https://www.caresearch.com.au/caresearch/tabid/3629/Default.aspx [Verified 27 September 2016]
Department of Health (2016c) Medicare Item Reports. Available at http://medicarestatistics.humanservices.gov.au/statistics/mbs_item.jsp [Verified 26 September 2016]
Dossett LA, Hudson JN, Morris AM, Lee MC, Roetzheim RG, Fetters MD, Quinn GP (2017) The primary care provider (PCP)–cancer specialist relationship: a systematic review and mixed-methods meta-synthesis. CA: a Cancer Journal for Clinicians 67, 156–169.
| The primary care provider (PCP)–cancer specialist relationship: a systematic review and mixed-methods meta-synthesis.Crossref | GoogleScholarGoogle Scholar |
Fukui M, Iwase S, Sakata N, Kuroda Y, Yoshiuchi K, Nakagawa K, Quinn K, Hudson PL (2013) Effectiveness of using clinical guidelines for conducting palliative care family meetings in Japan. Supportive Care in Cancer 21, 53–58.
| Effectiveness of using clinical guidelines for conducting palliative care family meetings in Japan.Crossref | GoogleScholarGoogle Scholar |
Government of South Australia (2014) More home support for palliative care. Available at http://www.premier.sa.gov.au/images/news_release/14_11Nov/morehomesupportforpalliativecare.pdf [Verified 14 August 2016]
Holden L, Williams ID, Patterson E, Smith JW, Scuffham PA, Cheung L, Chambers R, Golenko XA, Weare R (2012) Uptake of Medicare chronic disease management incentives – a study into service providers’ perspectives. Australian Family Physician 41, 973–977.
Hollingworth S, Zhang J, Vaikuntam BP, Jackson C, Mitchell G (2016) Case conference primary–secondary care planning at end of life can reduce the cost of hospitalisations. BMC Palliative Care 15, 84
| Case conference primary–secondary care planning at end of life can reduce the cost of hospitalisations.Crossref | GoogleScholarGoogle Scholar |
Luckett T, Phillips J, Agar M, Virdun C, Green A, Davidson PM (2014) Elements of effective palliative care models: a rapid review. BMC Health Services Research 14, 136
| Elements of effective palliative care models: a rapid review.Crossref | GoogleScholarGoogle Scholar |
Masso M, Fildes D, Quinsey K, Matete S (2007) GAPS revisited: follow up evaluation of an Australian rural palliative care service. Progress in Palliative Care 15, 233–239.
| GAPS revisited: follow up evaluation of an Australian rural palliative care service.Crossref | GoogleScholarGoogle Scholar |
Mitchell GK, De Jong IC, Del Mar CB, Clavarino AM, Kennedy R (2002) General practitioner attitudes to case conferences: how can we increase participation and effectiveness? The Medical Journal of Australia 177, 95–97.
Mitchell G, Cherry M, Kennedy R, Weeden K, Burridge L, Clavarino A, O’Rourke P, Del Mar C (2005) General practitioner, specialist providers case conferences in palliative care – lessons learned from 56 case conferences. Australian Family Physician 34, 389–392.
Mitchell GK, Del Mar CB, O’Rourke PK, Clavarino AM (2008) Do case conferences between general practitioners and specialist palliative care services improve quality of life? A randomised controlled trial (ISRCTN 52269003). Palliative Medicine 22, 904–912.
| Do case conferences between general practitioners and specialist palliative care services improve quality of life? A randomised controlled trial (ISRCTN 52269003).Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD1cjmslahsg%3D%3D&md5=793ffe2e38249dfe9ec65870a7eee9c9CAS |
Mitchell G, Zhang J, Burridge L, Senior H, Miller E, Young S, Donald M, Jackson C (2014) Case conferences between general practitioners and specialist teams to plan end of life care of people with end stage heart failure and lung disease: an exploratory pilot study. BMC Palliative Care 13, 24
| Case conferences between general practitioners and specialist teams to plan end of life care of people with end stage heart failure and lung disease: an exploratory pilot study.Crossref | GoogleScholarGoogle Scholar |
Mitchell GK, Burridge L, Zhang J, Donald M, Scott IA, Dart J, Jackson CL (2015) Systematic review of integrated models of health care delivered at the primary-secondary interface: how effective is it and what determines effectiveness? Australian Journal of Primary Health 21, 391–408.
| Systematic review of integrated models of health care delivered at the primary-secondary interface: how effective is it and what determines effectiveness?Crossref | GoogleScholarGoogle Scholar |
Patterson E, Muenchberger H, Kendall E (2007) The role of practice nurses in coordinated care of people with chronic and complex conditions. Australian Health Review 31, 231–238.
| The role of practice nurses in coordinated care of people with chronic and complex conditions.Crossref | GoogleScholarGoogle Scholar |
Shelby-James TM, Currow DC, Phillips PA, Williams H, Abernethy AP (2007) Promoting patient centred palliative care through case conferencing. Australian Family Physician 36, 961–964.
Shelby-James TM, Butow P, Davison G, Currow DC (2012) Case conferences in palliative care – a substudy of a cluster randomised controlled trial. Australian Family Physician 41, 608–612.
Singer AE, Ash T, Ochotorena C, Lorenz KA, Chong K, Shreve ST, Ahluwalia SC (2016) A systematic review of family meeting tools in palliative and intensive care settings. The American Journal of Hospice & Palliative Care 33, 797–806.
| A systematic review of family meeting tools in palliative and intensive care settings.Crossref | GoogleScholarGoogle Scholar |
Tuckett A, Parker D, Clifton K, Walker H, Reymond E, Prior T, Jenkin P, Israel F, Greeve K, Glaetzer K (2015) What general practitioners said about the palliative care case conference in residential aged care: an Australian perspective. Part 2. Progress in Palliative Care 23, 9–17.
| What general practitioners said about the palliative care case conference in residential aged care: an Australian perspective. Part 2.Crossref | GoogleScholarGoogle Scholar |
