Palliative care interventional research in general practice: a narrative review of factors affecting research conduct

Matthew Grant; Maike van der Waal; Tania Pastrana; Joel Rhee; Saskia Teunissen

doi:10.21037/apm-23-587

Palliative care interventional research in general practice: a narrative review of factors affecting research conduct

Ann Palliat Med. 2024 May 10:apm-23-587. doi: 10.21037/apm-23-587. Online ahead of print.

Authors

Matthew Grant¹, Maike van der Waal¹, Tania Pastrana², Joel Rhee³, Saskia Teunissen¹

Affiliations

¹ Centre of Expertise in Palliative Care Utrecht, Department of General Practice, Julius Centre, UMC Utrecht, Utrecht, The Netherlands.
² Department of Palliative Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany.
³ Discipline of General Practice, School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia.

PMID: 38735695
DOI: 10.21037/apm-23-587

Abstract

Background and objective: The majority of palliative care provision occurs in general practice, yet only 9% of palliative care clinical trials were conducted in this setting. Evidence from hospital and specialist settings is not readily transferable to general practice, as the population, context and care processes are vastly different. Conducting interventional palliative care research in general practice settings is subject to many challenges and barriers. This narrative review aims to describe the factors influencing the conduct of interventional research in general practice settings for patients with palliative care needs.

Methods: A narrative review was performed to identify factors affecting the conduct of palliative care interventional studies in general practice. A literature search of MEDLINE was conducted on 26 September 2023, and data were synthesised utilising a narrative approach.

Key content and findings: Sixteen articles were identified. Five thematic groupings were identified from the literature that affected the interventions: factors related to health care professionals (HCPs), patients and carers, general practices, health systems, and research design. HCPs and practices were focused on providing clinical care and struggled to incorporate research into their workload. Staff and patients often had negative perceptions in palliative care combined with limited research experience, often resulting in unwillingness to engage in interventions and gatekeeping. Engaging with general practice staff to design, participate and champion research were key facilitators of successful interventions.

Conclusions: Palliative care interventions in general practice are invariably complex and challenging, yet acutely needed to address the care needs of patients in the community setting. Working together with patients, carers and clinicians to design and implement interventions appropriate for general practice settings is fundamental to their success.

Keywords: Palliative care; clinical trials; general practice; interventional research; primary care.