Research aims to enhance care networks for end-of-life patients

Morgan Liotta

29/05/2020 1:52:11 PM

Witnessing how a comprehensive primary care team can benefits palliative patients inspired this GP researcher.

Dr Matthew Grant
Dr Matthew Grant hopes to improve GPs’ involvement in end-of-life care through increased data linkage and health service planning.

GP and palliative medicine physician Dr Matthew Grant recognises that the final six months of a person’s life are the most resource-intensive in terms of using the health system.
His research findings identified that the involvement of GPs in end-of-life care increases the probability of dying at home, decreases hospitalisations, and reduces adverse interventions.
Despite these findings demonstrating a marked relationship between increased continuity of care and reduction in health expenditure, particularly hospital services, Dr Grant also found provision of primary care data is lacking, identifying a gap in care.
Armed with the focus of improving the integration of primary care for palliative patients, particularly those with cancer, Dr Grant hopes to achieve this goal through better understanding and planning of primary and specialist services, informal care, and improving communication and collaboration at the practitioner level.
A 2019 RACGP Foundation/HCF Research Foundation grant* recipient, Dr Grant’s project is called ‘Establishing patterns of primary care usage at the end of life in cancer: Using indicators of quality end-of-life care in linked administrative data’.
‘As a GP, the care I saw for patients with cancer was often disjointed,’ he told newsGP.
‘Many patients disengage from their primary care team through acute cancer treatment. As their cancer progresses, the contact with the GP may continue to be minimal, until a point when primary care is suddenly asked to “jump in” to take on responsibility for care.
‘In my other role as a palliative care physician, I see the huge benefits that patients with supportive and involved primary care teams derive at the end of life.
‘Unfortunately, many patients lack this support, or are not regularly involved with their GP during the last months of their life.’
Dr Grant wanted to explore the contribution of general practice to cancer care in Australia, which is ‘often difficult to quantify’.
‘We are keen to explore how primary care services are being utilised by patients with cancer towards the end of their lives, the impacts of regular involvement of primary care, and how it affects quality of life,’ he said.
Melbourne University’s Cancer in Primary Care research group is currently linking primary care data with cancer registry, hospital, emergency and death data – the first of its kind ­­– which Dr Grant is utilising to assist his project.  
The data will include approximately 10,000 patient records and represent the first international study using large-linked administrative data focusing on primary care services at the end of life for cancer patients. It will use administrative indicators to understand the quality of care provided, as well as identify associations with the use of GP services.
Dr Grant believes the benefits of end-of-life primary care extend beyond the patient and providers to include the whole family, enabling a ‘good death’ at home.
However, he does note some challenges.
‘We all know GPs do a great job providing this care, but it is time-consuming, may require home and after-hours visits, can involve clinical and emotional challenges, and constant collaboration and communication with other services. That can be tricky,’ he said.
Dr Grant anticipates that the project findings will enable better insight into primary care’s contribution to palliative care, and inform health service planning to better integrate and coordinate end-of-life care.
‘I am hoping it will give us an understanding of how cancer patients are using primary care services, as at the moment the understanding is very poor,’ he said.
‘The initial data we have demonstrates just how often many patients are seeing their GPs in the last six months of life.
‘If we can quantify the huge contribution that primary care has at the end of life, it will do a significant amount to raise awareness within specialist services of the imperative for good integration and communication.’
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*In order to support members currently impacted by the COVID-19 pandemic, the RACGP is extending application dates for the 2020 Foundation grants. More information is available on the RACGP website.
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