End-of-life care in general practice: clinic-based data collection

BACKGROUND There are no processes that routinely assess end-of-life care in Australian general practice. This study aimed to develop a data collection process which could collect observational data on end-of-life care from Australian general practitioners (GPs) via a questionnaire and clinical data from general practice software. METHODS The data collection process was developed based on a modified Delphi study, then pilot tested with GPs through online surveys across three Australian states and data extraction from general practice software, and finally evaluated through participant interviews. RESULTS The developed data collection process consisted of three questionnaires: Basic Practice Descriptors (32 items), Clinical Data Query (32 items) and GP-completed Questionnaire (21 items). Data extraction from general practice software was performed for 97 decedents of 10 GPs and gathered data on prescriptions, investigations and referral patterns. Reports on care of 272 decedents were provided by 63 GPs. The GP-completed Questionnaire achieved a satisfactory level of validity and reliability. Our interviews with 23 participating GPs demonstrated the feasibility and acceptability of this data collection process in Australian general practice. CONCLUSIONS The data collection process developed and tested in this study is feasible and acceptable for Australian GPs, and comprehensively covers the major components of end-of-life care. Future studies could develop an automated data extraction tool to reduce the time and recall burden for GPs. These findings will help build a nationwide integrated information network for primary end-of-life care in Australia.

[1]  Big Data and End-of-Life Care: Promise and Peril. , 2016 .

[2]  A. Cook,et al.  How We Should Assess the Delivery of End-Of-Life Care in General Practice? A Systematic Review. , 2018, Journal of palliative medicine.

[3]  B. Onwuteaka-Philipsen,et al.  Palliative Care Service Use in Four European Countries: A Cross-National Retrospective Study via Representative Networks of General Practitioners , 2013, PloS one.

[4]  L. Deliens,et al.  Nationwide monitoring of end-of-life care via the Sentinel Network of General Practitioners in Belgium: the research protocol of the SENTI-MELC study , 2007, BMC palliative care.

[5]  A. Abernethy,et al.  Use of Electronic Health Record Data for Quality Reporting. , 2017, Journal of oncology practice.

[6]  D. Cicchetti,et al.  Developing criteria for establishing interrater reliability of specific items: applications to assessment of adaptive behavior. , 1981, American journal of mental deficiency.

[7]  Christopher Pearce,et al.  Optimising the use of observational electronic health record data: Current issues, evolving opportunities, strategies and scope for collaboration. , 2016, Australian family physician.

[8]  B. Onwuteaka-Philipsen,et al.  Nationwide continuous monitoring of end-of-life care via representative networks of general practitioners in Europe , 2013, BMC Family Practice.

[9]  Cheryl Tatano Beck,et al.  The content validity index: are you sure you know what's being reported? Critique and recommendations. , 2006, Research in nursing & health.

[10]  V. Braun,et al.  Using thematic analysis in psychology , 2006 .

[11]  Vasa Curcin,et al.  Possible Sources of Bias in Primary Care Electronic Health Record Data Use and Reuse , 2018, Journal of medical Internet research.

[12]  Jessica Bell,et al.  Gathering data for decisions: best practice use of primary care electronic records for research , 2019, The Medical journal of Australia.

[13]  F. Hasson,et al.  The Delphi Technique in Nursing and Health Research , 2011 .

[14]  K. Erny-Albrecht Use of chronic disease management software in Australia , 2015 .

[15]  G. Mitchell,et al.  Systematic review of general practice end-of-life symptom control , 2018, BMJ Supportive & Palliative Care.

[16]  Cheryl Tatano Beck,et al.  Is the CVI an acceptable indicator of content validity? Appraisal and recommendations. , 2007, Research in nursing & health.

[17]  J. Savulescu,et al.  Facilitating the ethical use of health data for the benefit of society: electronic health records, consent and the duty of easy rescue , 2016, Philosophical Transactions of the Royal Society A: Mathematical, Physical and Engineering Sciences.

[18]  Thomas M Gill,et al.  Trajectories of disability in the last year of life. , 2010, The New England journal of medicine.

[19]  P. Schattner,et al.  Clinical data extraction and feedback in general practice: a case study from Australian primary care. , 2010, Informatics in primary care.

[20]  B. Collins,et al.  Big Data analysis to improve care for people living with serious illness: The potential to use new emerging technology in palliative care , 2017, Palliative medicine.

[21]  Jason D. Baker,et al.  Online Survey Software , 2013 .

[22]  M. Groenvold,et al.  Danish Palliative Care Database , 2016, Clinical epidemiology.

[23]  Jinfeng Ding,et al.  Integrated information networks to support end-of-life care in general practice , 2018 .

[24]  N. Adler,et al.  Using Electronic Health Records for Population Health Research: A Review of Methods and Applications. , 2016, Annual review of public health.

[25]  A. Cook,et al.  End-of-life care in rural general practice: how best to support commitment and meet challenges? , 2019, BMC Palliative Care.

[26]  G. Mitchell,et al.  Attitudes and barriers to involvement in palliative care by Australian urban general practitioners. , 2008, Journal of palliative medicine.

[27]  Jane M. Young,et al.  Audit and feedback: effects on professional practice and healthcare outcomes. , 2012, The Cochrane database of systematic reviews.

[28]  C. Fürst,et al.  Developing a national quality register in end-of-life care: The Swedish experience , 2012, Palliative medicine.

[29]  Bee Wee,et al.  Using routine data to improve palliative and end of life care , 2016, BMJ Supportive & Palliative Care.

[30]  R. Fainsinger,et al.  Applying the Delphi process to palliative care tool development: lessons learned , 2008, Supportive Care in Cancer.

[31]  L. Deliens,et al.  Towards a standardized method of developing quality indicators for palliative care: protocol of the Quality indicators for Palliative Care (Q-PAC) study , 2013, BMC Palliative Care.

[32]  Megan E O'Brien,et al.  Alleviating the access abyss in palliative care and pain relief—an imperative of universal health coverage: the Lancet Commission report , 2017, The Lancet.

[33]  H. Britt,et al.  Reality check - reliable national data from general practice electronic health records , 2016 .