Barriers and facilitators to nurse-led advance care planning and palliative care practice change in primary healthcare: a qualitative study
Srivalli V. Nagarajan A B M , Virginia Lewis C , Elizabeth Halcomb
D , Joel Rhee E F , Rachael L. Morton G , Geoffrey K. Mitchell H , Jennifer Tieman I , Jane L. Phillips J , Karen Detering K , Jennifer Gavin L and Josephine M. Clayton A B
A Centre for Learning and Research in Palliative Care, HammondCare, Greenwich Hospital, Sydney, NSW, Australia.
B Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
C Australian Institute for Primary Care and Ageing, La Trobe University, Melbourne, Vic., Australia.
D School of Nursing, The University of Wollongong, Wollongong, NSW, Australia.
E Centre for Positive Ageing and Care, HammondCare, Sydney, NSW, Australia.
F Graduate School of Medicine, The University of Wollongong, Wollongong, NSW, Australia.
G NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
H Mayne Academy of Primary Care, Faculty of Medicine, University of Queensland, Brisbane, Qld, Australia.
I Research Centre for Palliative Care, Death and Dying, Flinders University, Adelaide, SA, Australia.
J Faculty of Health, School of Nursing, Queensland University of Technology, Brisbane, Qld, Australia.
K Department of Health, Arts and Design, Swinburne University, Melbourne, Vic., Australia.
L Centre for Cancer and Palliative Care Outcomes, Faculty of Health, Queensland University of Technology, Brisbane, Qld, Australia.
M Corresponding author. Email: srivalli.nagarajan@sydney.edu.au
Australian Journal of Primary Health 28(2) 151-157 https://doi.org/10.1071/PY21081
Submitted: 22 April 2021 Accepted: 10 November 2021 Published: 8 February 2022
Journal Compilation © CSIRO 2022 Open Access CC BY-NC-ND
Abstract
Primary care settings are ideal for initiating advance care planning (ACP) conversations and assessing palliative and supportive care needs. However, time constraints and a lack of confidence to sensitively and efficiently initiate such discussions are noted barriers. The Advance Project implemented a national multicomponent training package to support Australian general practice nurses (GPNs) to work with GPs to initiate ACP and palliative care conversations in their practice. This paper reports on semistructured interviews conducted with 20 GPNs to explore barriers and facilitators to implementing the Advance Project model. Participants identified a range of factors that affected implementation, including lack of time, limited support from colleagues, lack of knowledge about systems and funding processes in general practice and a need for better alignment of the Advance Project resources and practices with general practice information management platforms. Barriers related to professional roles, particularly the lack of clarity and/or limitations in the scope of practice of GPNs, highlighted the importance of defining and supporting the roles that different primary health practice staff could play to support implementation of the model. The findings underline the need for complementary training in the Advance Project model for GPs and practice managers to enable a team-based approach to implementation.
Keywords: advance care planning, general practice, primary healthcare, palliative care, general practice nurses, patient care.
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