Improving identification of patients who are likely to have palliative care needs in primary care in the UK

Palliative care is essential for improving the quality of life for patients with advanced illnesses, yet timely identification and referral remain significant challenges, especially in primary care settings.

This thesis aims to explore the process of identifying patients who may benefit from palliative care, focusing on existing screening tools, barriers to timely identification, and the potential benefits of electronic screening tools.

A systematic review (Study One) identified various screening tools used to identify patients with advanced progressive diseases likely to have palliative care needs. The review found significant variability in the effectiveness and usability of these tools, highlighting the need for more standardised approaches.

Observational studies (Studies Two and Three) used data from the National Survey of Bereaved People (VOICES) to examine factors associated with improved pain relief and end-of-life care experiences. The studies found that receiving specialist palliative care at home and having good continuity of primary care were associated with better outcomes.

A qualitative study (Study Four) explored barriers to the timely identification of patients with cancer in primary care and the potential benefits of electronic screening. Barriers identified included the absence of a systematic approach, resource limitations, and poor communication. The study also highlighted the positive impact of electronic screening tools in improving efficiency and standardisation.

Overall, the findings emphasise the importance of timely identification and referral to palliative care, particularly for patients with non-cancer illnesses who are often underrepresented in palliative care services. The research underscores the need for more inclusive and standardised approaches to ensure that all patients with palliative care needs receive appropriate and timely care.