Many people in Scotland now benefit from anticipatory care before they die: an after death analysis and interviews with general practitioners

Background Key Information Summaries (KIS)

were introduced throughout Scotland in 2013 so

that anticipatory care plans written by general

practitioners (GPs) could be routinely shared

electronically and updated in real time, between

GPs and providers of unscheduled and secondary

care.

Aims We aimed to describe the current reach of

anticipatory and palliative care, and to explore

GPs’ views on using KIS.

Methods We studied the primary care records

of all patients who died in 2014 in 9 diverse

Lothian practices. We identified if anticipatory or

palliative care had been started, and if so how

many weeks before death and which aspects of

care had been documented. We interviewed 10

GPs to understand barriers and facilitating

factors.

Results Overall, 60% of patients were identified

for a KIS, a median of 18 weeks before death.

The numbers identified were highest for patients

with cancer, with 75% identified compared with

66% of those dying with dementia/frailty and

only 41% dying from organ failure. Patients

were more likely to die outside hospital if they

had a KIS. GPs identified professional, patient

and societal challenges in identifying patients for

palliative care, especially those with non-cancer

diagnoses.

Conclusions GPs are identifying patients for

anticipatory and palliative care more equitably

across the different disease trajectories and

earlier in the disease process than they were

previously identifying patients specifically for

palliative care. However, many patients still lack

care planning, particularly those dying with

organ failure.