Exploring the role of GPs in palliative care

GPs have been reminded of the valuable role they play in palliative care, with experts highlighting the many skills across general practice that enable patients to receive excellent care.
 
Yet some misconceptions remain around areas including scope of practice for GPs, the involvement of palliative care teams, and when a palliative care approach can begin.
 
The attention comes as Palliative Care Australia (PCA) shines a light on the national Dying to Know day on 8 August, which brings Australians together to start conversations about death, dying and grief.
 
Each August, hundreds of community events and activities are held across the country, encouraging people to learn about, discuss and plan for end-of-life wishes.
 
For GPs, it’s a good opportunity to reflect on their role in this important area of medicine – one which Associate Professor Joel Rhee, RACGP Specific Interests Cancer and Palliative Care Chair, finds to be very rewarding.
 
‘Many GPs, myself included, find palliative care to be one of the most rewarding parts of medicine because of the continuity of care and the opportunity to support patients and families through a significant stage of life,’ he told newsGP.
 
Associate Professor Rhee said GPs and general practice teams already have many of the skills needed to provide excellent palliative care, including their community orientation and holistic approach to care which makes them highly effective.
 
But he finds a common misconception is to ‘conflate a palliative approach to care with specialist palliative care services’.
 
‘People often talk about “referring to palliative care”, when what they usually mean is referring to a specialist palliative care team.
 
‘A palliative approach to care, however, is something that all health professionals caring for people with advanced illness should be able to provide, including GPs.’
 
Associate Professor Rhee said most patients can receive high-quality palliative care in general practice, supported by specialist palliative care services when required.
 
‘The reality is that specialist palliative care services simply do not have the capacity to provide direct care for everyone approaching the end of life.
 
‘Specialist services therefore focus much of their effort on supporting GPs and general practice teams, while providing direct care for patients with particularly complex needs.’
 
The World Health Organization defines palliative care as ‘an approach that improves the quality of life of patients (adults and children) and their families who are facing problems associated with life-threatening illness’.
 
‘It prevents and relieves suffering through the early identification, correct assessment and treatment of pain and other problems, whether physical, psychosocial or spiritual,’ it says.
 
Associate Professor Rhee says this definition aligns closely with the principles of good general practice and the way many GPs already care for their patients.
 
‘There is evidence that GPs and general practice teams can provide high-quality palliative care, particularly when they are well supported by specialist palliative care services,’ he said.
 
‘Some of the most challenging aspects of care involve communication, emotional and psychological support, care coordination and bereavement support. These are areas where experienced GPs and practice nurses often excel.
 
‘Ongoing professional development in palliative care is important especially in end-of-life care communication skills, advance care planning and symptom management, but many of the core skills required are already part of everyday general practice.’
 
Another common misconception among GPs is that palliative care is only relevant for people who are actively dying or who have exhausted all options for disease-directed treatment, Associate Professor Rhee said.
 
‘In fact, a palliative approach is about identifying and addressing uncontrolled symptoms and unmet needs. It is often most effective when introduced early and can be provided alongside treatments that are intended to prolong life,’ he explained.
 
‘Doing this well starts with identifying people who may be at risk of deteriorating health and death, and then assessing them for symptoms and care needs.’
 
Palliative Care Australia Chief Executive Dr Chris Hatherly agrees that one of the biggest misconceptions is that palliative care only begins when active treatment ends or someone is in the last days of life.
 
‘In reality, palliative care can be provided alongside active treatment, focusing on advance care planning, quality of life, symptom management and helping people navigate a life-limiting or terminal illness,’ he told newsGP.
 
‘For GPs, it’s a reminder of the important role they play in creating opportunities for these discussions.
 
‘Patients don’t need all the answers in one appointment; often they just need a trusted clinician to guide the discussion.’
 
Dr Hatherly said GPs remain ‘at the heart of high-quality palliative care’ because they often have longstanding relationships with patients and families.
 
‘Sometimes the most valuable intervention isn’t another test or referral; it’s taking the time to ask what matters most to the person and ensuring their care continues to reflect those priorities,’ he said.
 
‘Good palliative care isn’t about choosing between treatment and comfort.
 
‘It’s about making sure people receive the right care at the right time, while continuing to support hope and quality of life throughout a life-limiting or terminal illness.’
 
And there are several resources that can support GPs in this.
 
‘Tools such as the Surprise Question (“Would you be surprised if this patient died in the next 6–12 months?”) and SPICT [the Supportive and Palliative Care Indicators Tool] can help clinicians identify patients who may benefit from a palliative approach,’ Associate Professor Rhee said.
 
‘There are also a range of tools available to support symptom assessment. Many of these resources can be found through The Advance Project website.’
 
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end-of-life care palliative care scope of practice