Abstract
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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.