PALLIATIVE CARE IN THE COMMUNITY - SETTING PRACTICE GUIDELINES FOR PRIMARY-CARE TEAMS

Background. Previous studies have demonstrated deficiencies in palliat ive care in the community. One method of translating the results of re search into clinical practice, in order to produce more effective heal th care, is the development of clinical guidelines. Setting standards for such care has been performed by care teams in both hospital and ho spice settings but not in primary care. Aim. This study set out to dev elop guidelines for primary care teams to follow in the provision of p alliative care in the community using facilitated case discussions wit h the members of such teams, as a form of internal audit. Method. Five practices were randomly chosen from the family health services author ity medical list. Meetings between the facilitators and primary care t eams were held over a period of one year. The teams were asked to desc ribe good aspects of care, areas of concern and suggestions to improve these, in recent cases of patient deaths. Results. In total 56 cases were discussed. All practices felt that cohesive teamwork, coordinated management, early involvement of nursing staff and the identification of a key worker were essential for good terminal care. Concerns arose in clinical and administrative areas but the majority were linked to poor communication, either between patient and professionals within th e primary care team or between primary and secondary care. All the pos itive aspects of care, concerns and suggestions were collated by the f acilitators into guidelines for teams to refer to from the initial dia gnosis of a terminal illness through to the patient's death and care o f the relatives afterwards. Conclusion. Developing multidisciplinary a s opposed to medical guidelines for palliative care allows primary hea lth care teams to create standards that are acceptable to them and sti mulates individuals within the reams to accept responsibility for init iating the change necessary for more effective care. The process of fa cilitating teams to discuss their work allows for recognition and resp ect of individuals' roles and more importantly provides shared ownersh ip, an important contributory factor in the implementation of guidelin es.