Abstract
BackgroundThe majority of severely ill and dying people in Germany can be administered primary palliative care (PPC) by general practitioners (GP). However, the current provision of PPC does not match the needs of the population. Although several public health strategies aim at strengthening the role of GPs in PPC provision, it remains challenging for GP teams to integrate PPC into their daily routines.AimA Delphi study with GPs was conducted to achieve consensus on specific measures for improving the integration of PPC into everyday GP practice.MethodsThe study is part of the junior research project “Primary Palliative Care in General Practice” (ALLPRAX). After having developed, tested and evaluated 26 practical measures for GP practices to improve their PPC, a Delphi consensus study among GPs took place. In 2020, 569 GPs were asked to rate the relevance and feasibility of the measures on a 4-point Likert scale via an anonymous online questionnaire. Consensus was defined as a sum percentage of ‘strongly agree’ and ‘somewhat agree’ responses ≥75% after two rounds. Between these rounds, measures that were not consented in the first round were adapted in light of respondents’ free text comments and suggestions.ResultsThe response rate was 11.3% in round 1 (n = 64) and 53.1% in round 2 (n = 34). From the initial n = 26 measures, n = 20 measures achieved consensus and were included in the final intervention package. The consented measures pertained to four main topics: advance care planning with patients, consulting and informing patients and family caregivers, GP office organisation and continuing education. N = 6 measures did not achieve consensus, predominantly due to time and workload constraints.ConclusionThe consented measures provide valuable support to improve the provision of PPC by GPs. They can be used freely and flexibly, according to the needs of individual GP teams, and are thus suitable for implementation nationwide.Trial registrationThe study was registered in the German Clinical Trials Register (Registration N° DRKS00011821; 4 December 2017; https://apps.who.int/trialsearch/) and the German Register of Health Care Research (Registration N° VfD_ALLPRAX_16_003817; 30 March 2017).
Highlights
The majority of severely ill and dying people in Germany can be administered primary palliative care (PPC) by general practitioners (GP)
The consented measures pertained to four main topics: advance care planning with patients, consulting and informing patients and family caregivers, GP office organisation and continuing education
The consented measures provide valuable support to improve the provision of PPC by GPs
Summary
The majority of severely ill and dying people in Germany can be administered primary palliative care (PPC) by general practitioners (GP). The number of dying people potentially in need of palliative care in Germany might have ranged from 374,536 to 729,359 in 2020. The majority of all seriously ill and dying patients, and especially those suffering from non-cancer diseases, can be cared for through primary palliative care (PPC) in Germany. The main providers of PPC are primary care professionals, general practitioners (GPs) and outpatient nursing services [5, 6]. Their main task is to recognize, prevent and reduce symptoms and problems of patients in need of palliative care. Whenever patients’ symptoms and problems exceed the possibilities of PPC, specialised palliative care providers take over [7]
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