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Appendix 3 Details of studies
Study, author, date & location Study design & aim Setting, sample size & participant
characteristics
Methods Quality
assessment
3.1 Patient factors
Early identification of palliative
care needs by family physicians:
A qualitative study of barriers
and facilitators from the
perspective of family
physicians,
community nurses, and patients
Beerneart,26 2014
Belgium.
Design: Qualitative
Aim: To explore the barriers to
and facilitators of the early
identification by family physicians
of the palliative care needs
Setting: Flanders region of Belgium
Participants: GPs, Palliative care and
general nurses working in the
community, eighteen patients
Qualitative: interviews and focus
groups with semi-
structured discussion guide
CASP
8/10
Palliative care by family
physicians in the 1990s.
Resilience amid reform
Burge,20 2001
Canada
Qualitative
Aim: to ascertain Family physician
perceptions of providing palliative
care in context of shrinking
hospital resources.
Setting: College of Physicians and
Surgeons, Nova Scotia.
Purposive sampling. 5 focus groups with
25 male and female GPs.
Focus groups
Audiotaped and transcribed
Thematic analysis
CASP 8/10
Home visits by family physicians
during the end-of-life: Does
patient income or residence
play a role?
Burge, 21 2005
Canada
Cohort
Aim: to examine the association
between patient income and
residence and the receipt of
Family Physician (FP) home visits
during the end-of-life among
patients with cancer
Setting: Data linkage from 3
administrative health databases and
Statistics Canada census records in
Ontario, Canada:
Participants: Registered patients
(n = 7212) who died between 1992 and
1997, with a confirmed cancer diagnosis,
≥ 18 years, and have a valid provincial
health insurance number.
Linked data set.
Studied relationship between income
and likelihood of a home visit in the
last six months of life or from
diagnosis to death if survival <6
months.
Control for neighbourhood income,
sex, year of death, age, cancer cause
of death, region of residency, the
NOS Cross-
sectional:
8/10
Supplementary material BMJ Support Palliat Care
doi: 10.1136/bmjspcare-2019-002109–11.:10 2020;BMJ Support Palliat Care, et al. Rhee JJ
number of visits made to a medical
specialist,
Understanding the provision of
palliative care in the context of
primary health care: Qualitative
research findings from a pilot
study in a community setting in
Chile.
Cameron,27 2009
Chile
Design: Hermeneutic
phenomenology
Aim: Understand the provision of
palliative care in the context of
primary health care (PHC).
Examine the PHC milieu as
a propitious one in which to
provide palliative care in a
developing country. Generate
opportunities for international
collaboration with Chile in areas
of public health, nursing and
palliative care.
Setting: PHC centres in
the Chiguayante district, Chile.
Population served – 33,000. Majority
low-income demographic.
Participants: 3 adults receiving palliative
care through the PHC, 2 family members,
2 PHC professionals (1 physician, 1
nurse).
Unstructured face-to-face interviews
and observation of patients and their
families as well as doctors and
practice nurses.
CASP
10/10
Involvement of general
practitioners in palliative cancer
care: A qualitative study
Dahlhaus,31 2013
Germany
Qualitative
Aim: to explore general
practitioners' perceptions of their
involvement in palliative cancer
care and the constraints they
confront
Setting: General Practice
Participants: Purposive sampling. 13 GPS
Qualitative interview schedule asking
open ended questions about last
palliative patient they had cared for.
Analysis: qualitative content analysis
according to Mayring
CASP 9/10
Barriers to home care for
terminally ill Turkish and
Moroccan migrants, perceived
by GPs and nurses; a survey
De Graaff,17 2008
Netherlands
Design: cross-sectional survey
Aim: (A) What experiences and
perceptions do
general practitioners and home
care nurses have with regard to
home care for terminally ill
Turkish and Moroccan migrants
and their families in the
Netherlands?
(B) What factors, according to
them, influence the access to and
Setting: GPs and home care nurses
working in economically deprived areas
of urban areas of Netherlands where
concentrations of Turks and Moroccans
are known to reside.
Participants: 124/326 invited
nurses (29%); 352/586 (60%) GPs
Survey with closed questions (yes/no
type) and open, free text responses
NOS Cross-
Sectional
6/10
Supplementary material BMJ Support Palliat Care
doi: 10.1136/bmjspcare-2019-002109–11.:10 2020;BMJ Support Palliat Care, et al. Rhee JJ
use of home care in
the terminal phase?
Reasons for hospitalisation at
the end of life: Differences
between cancer and non-cancer
patients
De Korte-Verhoef,18 2014
The Netherlands
Cross-sectional
Patients of participating GPs who
died of either cancer or non-
malignant disease and were
hospitalised within 3 months of
death.
Setting:Dutch general practice
Participants: 317 Deceased patients of
Dutch GPs
Patients identified from retrospective
reporting from a network of GPs, who
died and had been hospitalised within
3 months of death.
NOS Cross
Sectional
5/10
Burden for family carers at the
end of life; A mixed-method
study of the perspectives of
family carers and GPs
De Korte-Verhoef,19 2014
The Netherlands
Cross-sectional
Aimed to assess the link between
hospitalisation of a patient in the
last week of life and carer burden
Setting: Dutch General Practice
1. Quantitative questionnaire study
among 194 GPs and 74 family carers of
patients who died non-suddenly.
2. In-depth interviews were conducted
with 18 family carers.
Patients identified from retrospective
reporting from a network of GPs, who
died and had been hospitalised within
3 months of death.
NOS Cross-
Sectional
5/10
Palliative care provided by GPs:
The carer's viewpoint
Hanratty,22 2000
United Kingdom
Cross sectional
Aim: to explore bereaved carers'
views of the palliative care
provided by GPs
Setting: General practice
Participants: Bereaved carers who
registered a patient death from cancer in
a North Yorkshire district. 139/234 carers
who had registered a death from cancer
Postal survey using: the VOICES
survey and demographic questions
NOS Cross-
sectional: 5/5
(not all
elements of
assessment
relevant).
Rural general practitioner
perspectives of the needs
of Mãori patients requiring
palliative care.
Lawrenson,28 2010
New Zealand
Design: Cross-sectional survey
Aim: to identify rural GP
perspectives of the needs
of Mãori patients receiving
palliative care and what actions
Setting: Rural general practitioners
Participants 186/440 rural GPs sent the
survey
Postal survey with specifically
designed questionnaire
NOS: Cross
Sectional
2/5 (not all
elements of
assessment
relevant)
Supplementary material BMJ Support Palliat Care
doi: 10.1136/bmjspcare-2019-002109–11.:10 2020;BMJ Support Palliat Care, et al. Rhee JJ
the GPs had undertaken to meet
these needs.
Coordination of care for
individuals with advanced
progressive conditions: A multi-
site ethnographic and serial
interview study
Mason,23 2013
United Kingdom
Qualitative
Aim: to identify how and what
extent end of life care is
coordinated in generalist care.
Setting: Generalist clinical settings
producing three parallel case studies: an
acute admissions unit in a regional
hospital, a large general practice, and a
respiratory outpatient service.
Participants: 3 UK generalist clinical
settings.
A total of 56 patients, 25 family carers
and 17 clinicians yielded 198 interviews.
Ethnographic observations in each
setting were conducted for 22 weeks.
followed by semi-structured
interviews. Interviews every 8-12
weekly intervals with patients and or
carer and single interviews with
health professionals
CASP
Qualitative:
9/10
The role of primary care
physicians in advanced cancer
care: Perspectives of older
patients and their oncologists
O'Toole,30 2009
USA
RCT and Cross sectional
Aim: to identify age- related
differences in patient and
oncologist perspectives on
involvement of GPs
Setting: Teaching hospital-based cancer
clinics
Participants: 39 oncologists and 357
Patients who had an oncologist and PCP
enrolled 2 to 3 months after an advanced
cancer diagnosis
Survey - demographics and attitudes
to involvement of GP in ongoing care.
Patients were already part of a RCT
looking at a support intervention.
NOS Cross-
sectional:
2/10 (not all
elements of
assessment
relevant)
Palliative care service use in four
European countries: A cross-
national retrospective study via
representative networks of
general practitioners
Pivodic,25 2013
Belgium, Netherlands, Italy,
Spain
Cross sectional
Aim: to examine the number of
people receiving palliative care in
the last 3 months of life in 4
European countries, and the
factors associated with receiving
palliative care patients.
Setting: Epidemiological surveillance
networks of GPs in Belgium, the
Netherlands, Italy, and Spain
Participants: GPs who register patient
deaths. Sample size not required as all
non-sudden death patients included
Cross-national retrospective study
Over two years (2009-2010), GPs
registered weekly all deaths of
patients (>18 years) in their practices
and the care they received in the last
three months of life using a
standardized form. Sudden deaths
were excluded. A total of 4,466
deaths were studied.
NOS Cross-
sectional:
5/5 (not all
elements of
assessment
relevant)
Supplementary material BMJ Support Palliat Care
doi: 10.1136/bmjspcare-2019-002109–11.:10 2020;BMJ Support Palliat Care, et al. Rhee JJ
Barriers and facilitators to the
receipt of palliative care for
people with dementia: The
views of medical and nursing
staff
Ryan,24 2012
UK
Qualitative
Aim: explore the experiences of
health care practitioners working
in palliative care in order to
establish the issues relating to end
of life care for people with
dementia
Setting: Hospital, general practice,
hospice and specialist palliative care unit
Participants: Eight focus groups and four
individual interviews.
n = 58 palliative care GPS, nursing and
allied health professionals.
Focus groups and individual
interviews
Recorded and transcribed verbatim.
Transcripts read by 3 authors.
Computer software used to handle
data.
CASP
Qualitative:
10/10
How palliative care of cancer
patients is organised between a
University Hospital and primary
care in Finland
Tasmuth,28 2006
Finland
Cross sectional
Aim: to describe how palliative
care functions in practice in the
university hospital area; the need
for palliative care in primary care;
the problems related to
cooperation between the hospital
and primary care; the need for
training in palliative care
Setting: University Central Hospital
(University Hospital) and primary care
Participants: GPs and patients. 110
patients agreed to participate, 8 died
before survey; 102 at first interview; (71
- 70% patients one week later, 45 - 65%
one month after than;60 - 60%; 15 - 52%
at 6 months; 6 mths later 6 out of 9
43 GPs for 61 patients (60% response)
Patients were interviewed by phone
using a structured questionnaire. A
survey questionnaire was used to
collect data from the primary care
physic ians.
NOS Cross-
sectional:
5/10
3.2 Personal GP factors
Early identification of palliative
care needs by family physicians:
A qualitative study of barriers
and facilitators from the
perspective of family
physicians,
community nurses, and patients
Beerneart,26 2014
Belgium.
Design: Qualitative
Aim: To explore the barriers to
and facilitators of the early
identification by family physicians
of the palliative care needs
Setting: Flanders region of Belgium
Participants: GPs, Palliative care and
general nurses working in the
community, eighteen patients
Qualitative: interviews and focus
groups with semi-
structured discussion guide
CASP
8/10
Supplementary material BMJ Support Palliat Care
doi: 10.1136/bmjspcare-2019-002109–11.:10 2020;BMJ Support Palliat Care, et al. Rhee JJ
Understanding the provision of
palliative care in the context of
primary health care: Qualitative
research findings from a pilot
study in a community setting in
Chile.
Cameron,27 2009
Chile
Design: Hermeneutic
phenomenology
Aim: Understand the provision of
palliative care in the context of
primary health care (PHC).
Examine the PHC milieu as
a propitious one in which to
provide palliative care in a
developing country. Generate
opportunities for international
collaboration with Chile in areas
of public health, nursing and
palliative care.
Setting: PHC centres in
the Chiguayante district, Chile.
Population served – 33,000. Majority
low-income demographic.
Participants: 3 adults receiving palliative
care through the PHC, 2 family members,
2 PHC professionals (1 physician, 1
nurse).
Unstructured face-to-face interviews
and observation of patients and their
families as well as doctors and
practice nurses.
CASP
10/10
Factors enabling shared care
with primary healthcare
providers in community
settings: The experiences of
interdisciplinary palliative care
teams.
DeMiglio,39 2012
Canada
Design: Case study. Semi-
structured focus groups. Adapted
thematic content analysis.
Aim: Examine how palliative care
teams negotiate barriers in order
to share mutual responsibility for
patients with primary healthcare
providers
Setting: Southern Ontario, Canada, Local
Health Integration Networks (LHIN).
Participants: 5 palliative care teams
consisting of student learners on
rotation, community nurses and the
clinicians themselves.
Semi-structured focus groups and
interviews.
CASP 8/10
Obstacles to the delivery of
primary palliative care as
perceived by GPs
Groot,38 2007
Netherlands
Cross sectional
Aim: From a previous qualitative
study using focus groups, we
learned that GPs experienced
barriers on three different levels,
namely: personal, relational and
organizational. We aimed to
identify the frequency of the
various barriers and its
determinants.
Setting: General practice
Participants: 320 GPs out of 514 (62%)
GPs posted written questionnaires
together with a covering letter
explaining the aims of the study and a
stamped addressed return envelope.
NOS Cross-
sectional:
4/10 (not all
elements of
assessment
relevant)
Supplementary material BMJ Support Palliat Care
doi: 10.1136/bmjspcare-2019-002109–11.:10 2020;BMJ Support Palliat Care, et al. Rhee JJ
Palliative care in Western
Australia: an assessment of
information and support needs
McConigley,34 2001
Australia
Cross sectional study
Aim: To explore the perspectives
of nurses from nursing homes,
home care and hospitals, and
family physicians concerning
hospital admissions at the end of
life and the circumstances in
which they consider them to be
justified
Setting: homes of GPs and nurses.
Participants: Rural nurses & allied health
= 55.4%. GPs = 50%
Total sample response rate -= 52%
Postal questionnaire.
Descriptive statistics for demographic
data.
Mann Whitney U test to analyse
group differences.
NOS Cross-
sectional:
8/10
General practitioners and their
possible role in providing
spiritual care: A qualitative
study
Murray,36 2003
United Kingdom
Qualitative
Aim: A) Do GPs perceive that they
have a role in providing spiritual
care? and B) What do GPs
perceive as helping and hindering
them in assessing spiritual needs
and providing spiritual care?
Setting: General practices
Participants: General practitioners (GPs)
of 40 patients with life-threatening
illnesses over the course of the last year
of life.
Three monthly interviews of GPs of
patients with advanced heart failure
or lung cancer
CASP
Qualitative:
8/10
General practitioners’ attitudes
to palliative care: a Western
Australian rural perspective.
O’Connor,32 2006
Australia
Design: Semi-structured
interview.
Aim: To understand GPs’ attitudes
to palliative care in rural WA, what
factors contribute to GPs
attitudes to palliative care in rural
WA and what are the perceived
barriers to the provision of
palliative care in rural WA.
Setting: Rural WA.
Participants: 10 registered GPs located
within the Greater Bunbury Division of
General Practice. 8 Males, 2 females.
Semi-structured interview, open-
ended questions.
CASP 9/10
Supplementary material BMJ Support Palliat Care
doi: 10.1136/bmjspcare-2019-002109–11.:10 2020;BMJ Support Palliat Care, et al. Rhee JJ
General Practitioners'
experiences of bereavement
care and their educational
support needs: a qualitative
study
O'Connor,33 2014
Australia
Cross-sectional
Aim: to explore GPs
understandings of bereavement
care and their education and
professional development needs
in relation to bereavement care
Setting: General practice
Participants: 19 GPS were participated in
exploratory semi structured interview
Semi structured interviews, social
constructionist methodology
CASP
Qualitative:
9/10
Palliative care service use in four
European countries: A cross-
national retrospective study via
representative networks of
general practitioners
Pivodic,25 2013
Belgium, Netherlands, Italy,
Spain
Cross sectional
Aim: to examine the number of
people receiving palliative care in
the last 3 months of life in 4
European countries, and the
factors associated with receiving
palliative care patients.
Setting: Epidemiological surveillance
networks of GPs in Belgium, the
Netherlands, Italy, and Spain
Participants: GPs who register patient
deaths. Sample size not required as all
non-sudden death patients included
Cross-national retrospective study
Over two years (2009-2010), GPs
registered weekly all deaths of
patients (>18 years) in their practices
and the care they received in the last
three months of life using a
standardized form. Sudden deaths
were excluded. A total of 4,466
deaths were studied.
NOS Cross-
sectional:
5/5 (not all
elements of
assessment
relevant)
What influences the willingness
of community physicians to
provide palliative care for
patients with terminal cancer?
Evidence from a nationwide
survey
Peng,40 2013
Taiwan
Cross sectional
Aim: A) to identify community
physicians’ willingness to provide
palliative care in their
communities when they
encounter patients with terminal
cancer and B) to investigate the
factors that influence their
willingness to provide palliative
care.
Setting: General practices in
metropolitan, regional and rural Taiwan
Participants: 708 community physicians
who were potential pilots to provide
palliative care. Four hundred and ten
valid questionnaires (58.0%) were
retrieved and analysed.
A structured questionnaire NOS Cross
sectional 6/9
Attitudes and barriers to
involvement in palliative care by
Australian urban general
practitioners.
Rhee,35 2008
Design: Cross-sectional
Aim: To determine the level of
participation of Australian urban
GPs in palliative care and to
determine the main barriers
facing them in providing this care.
Setting: Sydney, Australia. 50% of surveys
sent to lower socioeconomic (SES) areas
and 50% sent to higher SES areas of
Sydney.
Participants: 500 GPs sent surveys. 269
returned.
Cross sectional postal survey.
Questions formulated with a panel of
experts in palliative care or GPs with
special interests in palliative care.
CASP 10/10
Supplementary material BMJ Support Palliat Care
doi: 10.1136/bmjspcare-2019-002109–11.:10 2020;BMJ Support Palliat Care, et al. Rhee JJ
Australia
Barriers and facilitators to the
receipt of palliative care for
people with dementia: The
views of medical and nursing
staff.
Ryan,24 2012
United Kingdom
Design: Focus group interviews
Aim: Explore the experiences of
health care practitioners working
in palliative care and establish the
issues relating to end of life care
for people with dementia.
Setting: Include acute hospitals, general
practices, hospices and specialist
palliative care unit in wo cities in the UK.
Participants: Consultants, junior doctors,
GPs, nurses, nurse specialists, allied
health professionals. Participants n = 58.
Semi-structured focus group
interviews.
CASP 9/10
Heartsink encounters: a
qualitative study of end-of-life
care in out-of-hours general
practice
Taubert et al,37 2011
United Kingdom
Qualitative
Aim: to establish how prepared
GPs who work regular out-of-
hours shifts feel when dealing
with end-of-life issues in palliative
care patients, what they thought
about seeing such patients and
whether they considered
themselves emotionally equipped
to do so.
Setting: General practice
Participants: GPs who worked regular
out-of-hours shifts - 9 out of 60.
Semi-structured interviews
A detailed analysis of transcripts using
Interpretative Phenomenological
Analysis was undertaken
CASP
Qualitative:
8/10
3.3 GP Practice factors
Delivery strategies to optimize
resource utilization and
performance status for patients
with advanced life-limiting
illness: Results from the
"palliative care trial"
Abernethy,41 2013
Australia
RCT
Aim: to improve on current
models of service provision of
palliative care.
Setting: Community-based palliative care
service
Participants: 461 patients and 228 GPs in
105 practices
Cluster randomised by GP practice:
Study 1: 3:1, n=461
Case conferencing n=358; received
n=167 (47%)
No case conferencing n=103; control
received n=0
Study 2: 1:1, n=461
JDAD 6/8
Supplementary material BMJ Support Palliat Care
doi: 10.1136/bmjspcare-2019-002109–11.:10 2020;BMJ Support Palliat Care, et al. Rhee JJ
GP education n= 195; received n=174
(89%)
No GP education n=266; control
received n=1 (<1%)
Palliative care for older people –
exploring the views of doctors
and nurses from different fields
in Germany
Brueckner,49 2009
Germany
Qualitative
Aim: to explore various health
providers' perceptions
and attitudes concerning the
delivery of palliative care to older
persons in Germany.
Setting: Geriatric institutions and
referring GPs in Hannover, Germany
Participants: Twenty-nine participants in
seven focus groups (general
practitioners, geriatricians, palliative care
physicians, palliative care nurses and
general nurses).
Qualitative, focus groups CASP
9/10
Palliative care by family
physicians in the 1990s.
Resilience amid reform
Burge,21 2001
Canada
Qualitative
Aim: to ascertain Family physician
perceptions of providing palliative
care in context of shrinking
hospital resources.
Setting: College of Physicians and
Surgeons, Nova Scotia.
Purposive sampling. 5 focus groups with
25 male and female GPs.
Focus groups
Audiotaped and transcribed
Thematic analysis
CASP 8/10
Roles, service knowledge and
priorities in the provision of
palliative care: A postal survey
of London GPs
Burt,48 2006
United Kingdom
Cross sectional
Aim: to explore general
practitioners’ (GPs) current
involvement in and attitudes
towards the provision of palliative
care in primary care.
Setting: General Practice
Participants: Purposive sampling. 620
postal surveys were posted to GPS and
356 (57%) completed questionnaires.
Postal survey of 356 London-based
GPs,
Pearson chi squared tests and
multiple linear regression was used in
data analysis
NOS Cross-
sectional: 4/5
(not all
elements of
assessment
relevant)
Barriers to home care for
terminally ill Turkish and
Moroccan migrants, perceived
by GPs and nurses; a survey
De Graaff,17 2008
Netherlands
Design: cross-sectional survey
Aim: (A) What experiences and
perceptions do
general practitioners and home
care nurses have with regard to
home care for terminally ill
Turkish and Moroccan migrants
Setting: GPs and home care nurses
working in economically deprived areas
of urban areas of Netherlands where
concentrations of Turks and Moroccans
are known to reside.
Survey with closed questions (yes/no
type) and open, free text responses
NOS Cross-
Sectional
6/10
Supplementary material BMJ Support Palliat Care
doi: 10.1136/bmjspcare-2019-002109–11.:10 2020;BMJ Support Palliat Care, et al. Rhee JJ
and their families in the
Netherlands?
(B) What factors, according to
them, influence the access to and
use of home care in
the terminal phase?
Participants: 124/326 invited
nurses (29%); 352/586 (60%) GPs
Burden for family carers at the
end of life; A mixed-method
study of the perspectives of
family carers and GPs
De Korte-Verhoef,19 2014
The Netherlands
Cross-sectional
Aimed to assess the link between
hospitalisation of a patient in the
last week of life and carer burden
Setting: Dutch General Practice
1. Quantitative questionnaire study
among 194 GPs and 74 family carers of
patients who died non-suddenly.
2. In-depth interviews were conducted
with 18 family carers.
Patients identified from retrospective
reporting from a network of GPs, who
died and had been hospitalised within
3 months of death.
NOS Cross-
Sectional
5/10
Factors enabling shared care
with primary healthcare
providers in community
settings: The experiences of
interdisciplinary palliative care
teams.
DeMiglio,39 2012
Canada
Design: Case study. Semi-
structured focus groups. Adapted
thematic content analysis.
Aim: Examine how palliative care
teams negotiate barriers in order
to share mutual responsibility for
patients with primary healthcare
providers
Setting: Southern Ontario, Canada, Local
Health Integration Networks (LHIN).
Participants: 5 palliative care teams
consisting of student learners on
rotation, community nurses and the
clinicians themselves.
Semi-structured focus groups and
interviews.
CASP 8/10
Information transfer to out-of-
hours co-operatives: a survey of
general practitioners' views in
relation to palliative patients
Kiely,50 2013
Ireland
Cross-sectional
Aim: (A) Assess views of GPs on
the importance of developing a
formalised method of information
transfer,(B) Assess the type of
information consider important or
necessary (C) describe perceived
current barriers to care provision
for PC patients and (D) to provide
Setting: GPs registry in the Irish Medical
Directory in the southwest of Ireland.
Participants: Questionnaire sent to 414
GPs. 214 (52% of the 414) responded to
the survey.
Postal questionnaire with stamped
addressed envelope. A reminder was
sent.
NOS Cross-
sectional:
7/10
Supplementary material BMJ Support Palliat Care
doi: 10.1136/bmjspcare-2019-002109–11.:10 2020;BMJ Support Palliat Care, et al. Rhee JJ
a evidence base to develop an
electronic palliative care summary
An analysis of calls to an out-of-
hours palliative care advice line
Lloyd-Williams,45 2003
United Kingdom
Cross sectional study
Aim: to evaluate the use of an
after-hours advice line for non-
registered patients.
Setting: Hospital
Participants: A senior member of nursing
staff or medical staff answered all calls.
98 calls were received. The majority of
callers were GPs (55%) and community
nurses (34%).
Analysis of after hour calls for all
palliative care patients
NOS Cross-
sectional: 2/5
(not all
elements of
assessment
relevant)
Do case conferences between
general practitioners and
specialist palliative care services
improve quality of life? A
randomised controlled trial
(ISRCTN 52269003)
Mitchell,42 47 2008
Australia
RCT
Aim: Do case conferencing
improve QOL for palliative care?
Setting: General practice and hospital
Intervention: case conference vs usual
care
Participants: 159 palliative care patients.
A multi-centred randomised
controlled trial of specialist- GP case
conferences, with the GP
participating by teleconference, or
usual care and communication
methods.
An intention-to-treat analyses were
conducted using recruitment, and
time of death, as fixed time points.
JDAD: 3/8
.
Case conferences between
general practitioners and
specialist teams to plan end of
life care of people with end
stage heart failure and lung
disease: an exploratory pilot
study
Mitchell,43 48 2014
Australia
Controlled before and after
Aim: to assess the effectiveness of
case conferences between
specialist teams and GP in
improving patient outcomes for
people with end stage heart
failure or lung disease.
Setting: General practice
Intervention: Case conference between
GP, palliative care physician and case
management nurse.
Participants: Twenty-three case
conferences involving 21 GPs were
conducted between November 2011 and
November 2012
Rates of service utilisation
(emergency department [ED]
presentations, ED discharges back to
home, hospital admissions, and
admission length of stay) before and
after case conference were calculated
NOS Cohort
4/5 (not all
elements of
assessment
relevant).
Supplementary material BMJ Support Palliat Care
doi: 10.1136/bmjspcare-2019-002109–11.:10 2020;BMJ Support Palliat Care, et al. Rhee JJ
Providing end-of-life care in
general practice: findings of
a national GP questionnaire
survey.
Mitchell,47 2016
United Kingdom
Web survey – Qualitative analysis
of free text questions
Aims: Describe-
What is the current experience of
GPs delivering EOLC?
What barriers and facilitators do
they identify to the provision of
EOLC?
Setting:
General practitioners responding to a
national online survey.
Participants: 516 GPs widely distributed
through England, some from Scotland
and Wales.
Questionnaire with free text
responses
CASP
Qualitative
8/10
What influences the willingness
of community physicians to
provide palliative care for
patients with terminal cancer?
Evidence from a nationwide
survey
Peng,40 2013
Taiwan
Cross sectional
Aim: A) to identify community
physicians’ willingness to provide
palliative care in their
communities when they
encounter patients with terminal
cancer and B) to investigate the
factors that influence their
willingness to provide palliative
care.
Setting: General practices in
metropolitan, regional and rural Taiwan
Participants: 708 community physicians
who were potential pilots to provide
palliative care. Four hundred and ten
valid questionnaires (58.0%) were
retrieved and analysed.
A structured questionnaire NOS Cross
sectional 6/9
End-of-life care from the
perspective of primary care
providers.
Silveira, 51. 2012
USA
Qualitative
Aim: To explore the factors
influencing primary care
providers’ ability to care for their
dying patients in Michigan, USA
Setting: Primary care practices (General
internal medicine and primary care) in
south-east Michigan
Participants: 28 Primary care
practitioners and 22 clinical support staff
including 10 registered nurses in 16 focus
groups
In-depth focus groups CASP
Qualitative
10/10
Improving generalist end of life
care: National consultation with
practitioners, commissioners,
academics, and service user
groups
Shipman,46 2008
Qualitative
Aim: to identify major concerns in
the commissioning, provision,
research and use of generalist end
of life care
Setting: Primary and secondary care,
specialist palliative care, and academic
and voluntary sectors in England and
Scotland.
Participants: Healthcare practitioners,
commissioners, academics, and
Qualitative approach: a national
consultation and prioritising exercise
using a modified form of the nominal
group technique.
CASP
Qualitative:
8/10
Supplementary material BMJ Support Palliat Care
doi: 10.1136/bmjspcare-2019-002109–11.:10 2020;BMJ Support Palliat Care, et al. Rhee JJ
United Kingdom representatives of user and voluntary
groups. 74% of those invited (210/285)
participated.
GP and nurses' perceptions of
how after hours care for people
receiving palliative care at home
could be improved: a mixed
methods study
Tan,44 2009,
Australia
Design: Cross-sectional survey
Aim: To identify barriers to the
provision of after-hours palliative
Care in Australian general
practice.
Setting: three Divisions of General
Practice (one each of urban, regional
and rural areas)
Participants: 114/524 (22%) GPs and
52/112 (43%) community nurses
Questionnaire based on
previous qualitative study.
NOS Cross-
sectional
2/5 (not all
elements of
assessment
relevant).
3.4 Relational factors
Interdisciplinary cooperation of
GPs in palliative care at home: A
nationwide survey in the
Netherlands
Borgsteede,54 2007
Netherlands
Design: Cross-sectional survey
To investigate
the prevalence and predictors of
interdisciplinary cooperation of
GPs with other caregivers in
palliative care at home.
Setting: Second Dutch survey in General
Practice
Participants: 743 decedents in 96
practices of 2143 deaths, who received
palliative care.
Questionnaire NOS Cross-
sectional
6/9
Palliative care for older people –
exploring the views of doctors
and nurses from different fields
in Germany
Brueckner,49 2009
Germany
Qualitative
Aim: to explore various health
providers' perceptions
and atti- tudes concerning the
delivery of palliative care to older
persons in Germany.
Setting: Geriatric institutions and
referring GPs in Hannover, Germany
Participants: Twenty-nine participants in
seven focus groups (general
practitioners, geriatricians, palliative care
physicians, palliative care nurses and
general nurses).
Qualitative, focus groups CASP
9/10
Supplementary material BMJ Support Palliat Care
doi: 10.1136/bmjspcare-2019-002109–11.:10 2020;BMJ Support Palliat Care, et al. Rhee JJ
Rural general practitioner
perspectives of the needs
of Mãori patients requiring
palliative care.
Lawrenson,29 2010
New Zealand
Design: Cross-sectional survey
Aim: to identify rural GP
perspectives of the needs
of Mãori patients receiving
palliative care and what actions
the GPs had undertaken to meet
these needs.
Setting: Rural general practitioners
Participants 186/440 rural GPs sent the
survey
Postal survey with specifically
designed questionnaire
NOS: Cross
Sectional
2/5 (not all
elements of
assessment
relevant)
Coordination of care for
individuals with advanced
progressive conditions: A multi-
site ethnographic and serial
interview study
Mason,23 2013
United Kingdom
Qualitative
Aim: to identify how and what
extent end of life care is
coordinated in generalist care.
Setting: Generalist clinical settings
producing three parallel case studies: an
acute admissions unit in a regional
hospital, a large general practice, and a
respiratory outpatient service.
Participants: 3 UK generalist clinical
settings.
A total of 56 patients, 25 family carers
and 17 clinicians yielded 198 interviews.
Ethnographic observations in each
setting were conducted for 22 weeks.
followed by semi-structured
interviews. Interviews every 8-12
weekly intervals with patients and or
carer and single interviews with
health professionals
CASP
Qualitative:
9/10
Cancer Patients Use Hospital-
Based Care Until Death: A
Further Analysis of the Dutch
Bone Metastasis Study
Meeuse,55 2011
Netherlands
Design: Cross-sectional
study) Multiple Questionnaires d
uring RCT of radiation therapy for
bony metastases
Aim: To describe health
care utilization in cancer
patients with bony metastases,
and independent predictors
for that utilisation
Setting: Dutch Oncology and community
service providers
Participants: 661/860 (77%) potential
respondents
Multilevel logistic regression. NOS Cross-
Sectional
10/10
Supplementary material BMJ Support Palliat Care
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General practitioners’ attitudes
to palliative care: a Western
Australian rural perspective.
O’Connor,32 2006
Australia
Design: Semi-structured
interview.
Aim: To understand GPs’ attitudes
to palliative care in rural WA, what
factors contribute to GPs
attitudes to palliative care in rural
WA and what are the perceived
barriers to the provision of
palliative care in rural WA.
Setting: Rural WA.
Participants: 10 registered GPs located
within the Greater Bunbury Division of
General Practice. 8 Males, 2 females.
Semi-structured interview, open-
ended questions.
CASP 9/10
Palliative care service use in four
European countries: A cross-
national retrospective study via
representative networks of
general practitioners
Pivodic,25 2013
Belgium, Netherlands, Italy,
Spain
Cross sectional
Aim: to examine the number of
people receiving palliative care in
the last 3 months of life in 4
European countries, and the
factors associated with receiving
palliative care patients.
Setting: Epidemiological surveillance
networks of GPs in Belgium, the
Netherlands, Italy, and Spain
Participants: GPs who register patient
deaths. Sample size not required as all
non-sudden death patients included
Cross-national retrospective study
Over two years (2009-2010), GPs
registered weekly all deaths of
patients (>18 years) in their practices
and the care they received in the last
three months of life using a
standardized form. Sudden deaths
were excluded. A total of 4,466
deaths were studied.
NOS Cross-
sectional:
5/5 (not all
elements of
assessment
relevant)
An insight into the delivery of a
palliative approach in
residential aged care: The
general practitioner
perspective.
Phillips52 2009,
Australia
Design: Qualitative study
Aim: To investigate GP’s
perceptions and
understanding of a
palliative approach in
residential aged care.
Setting: Australian general practice
Participants: Convenience sample of
Thirteen GPs
Qualitative – Focus groups CASP
8/10
Healthcare professional’
perceptions toward inter-
professional collaboration in
palliative home care: a view
from Belgium.
Pype,56 2013
Belgium
Design: qualitative
Aim: to describe the views of GPs
toward inter-professional
teamwork in palliative care.
Setting: Primary care in urban and
rural Belgium
Participants: 29 participants purposively
recruited from three
groups: GPs, Primary Health Care Team
members, Continuing medical education
providers
Five focus groups, inductive analysis CASP
9/10
Supplementary material BMJ Support Palliat Care
doi: 10.1136/bmjspcare-2019-002109–11.:10 2020;BMJ Support Palliat Care, et al. Rhee JJ
Finding common ground to
achieve a “good death”: family
physicians working with
substitute decision-makers of
dying patients. A qualitative
grounded theory study.
Tan,57 2013
Canada
Design: Qualitative
Aim: to describe Canadian family
physicians’ experiences of conflict
with substitute decision-makers
of dying patients to identify
factors that may facilitate or
hinder the end-of-life decision-
making process.
Setting: Edmonton, Canada
Participants: Purposive sample of eleven
urban GPs
Individual semi-structured
interviews, Analysis using Grounded
theory methodology.
CASP
9/10
GP and nurses' perceptions of
how after hours care for people
receiving palliative care at home
could be improved: a mixed
methods study
Tan,44 2009,
Australia
Design: Cross-sectional survey
Aim: To identify barriers to the
provision of after-hours palliative
Care in Australian general
practice.
Setting: three Divisions of General
Practice (one each of urban, regional
and rural areas)
Participants: 114/524 (22%) GPs and
52/112 (43%) community nurses
Questionnaire based on
previous qualitative study.
NOS Cross-
sectional
2/5 (not all
elements of
assessment
relevant).
Promoting patient centred
palliative care through case
conferencing
Shelby-James,53 2007
Australia
Design: Cross- sectional
descriptive
Aim: To describe the
characteristics of case
conferences between general
practitioners and specialised
palliative care services (SPCS)
Setting Community specialist/GP case
conferences
Participants: 461 patients of 230 GPs
were randomised to case conference vs
not.
Cross-sectional exploratory study of
selected characteristics of the case
conferences
NOS Cross-
sectional
5/5 (not all
elements of
assessment
relevant).
Supplementary material BMJ Support Palliat Care
doi: 10.1136/bmjspcare-2019-002109–11.:10 2020;BMJ Support Palliat Care, et al. Rhee JJ
3.5 Coordination of care
Palliative care for older people –
exploring the views of doctors
and nurses from different fields
in Germany
Brueckner,49 2009
Germany
Qualitative
Aim: to explore various health
providers' perceptions
and atti- tudes concerning the
delivery of palliative care to older
persons in Germany.
Setting: Geriatric institutions and
referring GPs in Hannover, Germany
Participants: Twenty-nine participants in
seven focus groups (general
practitioners, geriatricians, palliative care
physicians, palliative care nurses and
general nurses).
Qualitative, focus groups CASP
9/10
Understanding the provision of
palliative care in the context of
primary health care: Qualitative
research findings from a pilot
study in a community setting in
Chile.
Cameron,27 2009
Chile
Design: Hermeneutic
phenomenology
Aim: Understand the provision of
palliative care in the context of
primary health care (PHC).
Examine the PHC milieu as
a propitious one in which to
provide palliative care in a
developing country. Generate
opportunities for international
collaboration with Chile in areas
of public health, nursing and
palliative care.
Setting: PHC centres in
the Chiguayante district, Chile.
Population served – 33,000. Majority
low-income demographic.
Participants: 3 adults receiving palliative
care through the PHC, 2 family members,
2 PHC professionals (1 physician, 1
nurse).
Unstructured face-to-face interviews
and observation of patients and their
families as well as doctors and
practice nurses.
CASP
10/10
Involvement of general
practitioners in palliative cancer
care: A qualitative study
Dahlhaus,31 2013
Germany
Qualitative
Aim: to explore general
practitioners' perceptions of their
involvement in palliative cancer
care and the constraints they
confront
Setting: General Practice
Participants: Purposive sampling. 13 GPS
Qualitative interview schedule asking
open ended questions about last
palliative patient they had cared for.
Analysis: qualitative content analysis
according to Mayring
CASP 9/10
A national facilitation project to
improve primary palliative care:
Impact of the Gold Standards
Framework on process and self-
Controlled before and after
Aim: to describe the general
practices that participated in the
Setting: General practice
Intervention: The Gold Standards
Framework (GSF) for Palliative Care
Improvement on a self-report
questionnaire on practices’ provision
of palliative care and use of the GSF
NOS Cross-
sectional:
6/10
Supplementary material BMJ Support Palliat Care
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ratings of quality
Dale,60 2009
United Kingdom
GSF programme in 2003–5 and
the changes in process and
perception of quality that
occurred in the year following
entry into the programme, and to
identify factors associated with
the extent of change.
Participants: 837 practices expressed
interest in participation, of which 1455
(79.2%) registered for participation. Of
these, 1305 (89.7%) completed a
baseline questionnaire and 955 (73.2%)
submitted at least one follow-up
questionnaire.
Developing a framework for
primary palliative care services.
Daniels,58 2001
United Kingdom
Design: Mixed methods design
Aim: to evaluate current care
provision and explore methods of
developing palliative care services
in general practice.
Setting: Single urban general practice
Participants: 21 team members
associated with the general practice, 22
patients and their carers identified from
a records search.
Phase one: multiple team meetings
Phase two: questionnaires and
individual interviews with team
members to facilitate critical thinking
about palliative care service
provision.
CASP
9/10
Reasons for hospitalisation at
the end of life: Differences
between cancer and non-cancer
patients
De Korte-Verhoef,19 2014
Netherlands
Cross-sectional
Patients of participating GPs who
died of either cancer or non-
malignant disease and were
hospitalised within 3 months of
death.
Setting:Dutch general practice
Participants: 317 Deceased patients of
Dutch GPs
Patients identified from retrospective
reporting from a network of GPs, who
died and had been hospitalised within
3 months of death.
NOS Cross
Sectional
5/10
Factors enabling shared care
with primary healthcare
providers in community
settings: The experiences of
interdisciplinary palliative care
teams.
DeMiglio,39. 2012
Canada
Design: Case study. Semi-
structured focus groups. Adapted
thematic content analysis.
Aim: Examine how palliative care
teams negotiate barriers in order
to share mutual responsibility for
patients with primary healthcare
providers
Setting: Southern Ontario, Canada, Local
Health Integration Networks (LHIN).
Participants: 5 palliative care teams
consisting of student learners on
rotation, community nurses and the
clinicians themselves.
Semi-structured focus groups and
interviews.
CASP 8/10
Supplementary material BMJ Support Palliat Care
doi: 10.1136/bmjspcare-2019-002109–11.:10 2020;BMJ Support Palliat Care, et al. Rhee JJ
Shared care: The barriers
encountered by community-
based palliative care teams in
Ontario, Canada
DeMiglio,72 2012
Canada
Qualitative
Aim: to explore barriers to views
and experiences of community
based palliative care teams about
facilitators and barriers to shared
care with community based
primary care teams.
Setting: community-based palliative care
Participants: five community-based
palliative care teams and six key-
informants
Thematic analysis.
Synthesis of data using a 3-I
framework,
CASP 8/10
Experiences, knowledge and
opinions on palliative care
among Romanian general
practitioners.
Dumitrescu,77 2005
Design: Multi-choice
questionnaire – self assessment.
Aim: Assess experience,
knowledge and opinions of
Romanian GPs on palliative
healthcare in Romania.
Setting: 5 districts of Romania which
were representative of the nation in
areas of male/female ratio and death
rate. The authors noted that the
urban/rural proportion in the districts
chosen was not representative of the
nation.
Participants: 1283 general practitioners,
71% response rate.
Multi-choice questionnaires CASP 7/10
Cooperating with a palliative
home-care team: Expectations
and evaluations of GPs and
district nurses
Goldschmid,74 2005
Denmark
Cross sectional
Aim: to investigate whether GPs
and district nurses anticipated
and experienced benefits to
patients from the contact to the
palliative home-care team,
whether they learnt aspects of
palliative care from the contact,
and to assess their satisfaction in
cooperating with the home-care
team.
Setting: General practice
Participants: 82 GPs and 163 district
nurses received questionnaire 1, and 75
(91%) GPs and 148 (91%) district nurses
completed T1 143 GPs (82%) and 101
district nurses (76%) completed T2.
A palliative home-care team has been
established and make patient visits on
a regular basis and proposed
treatment changes to the GP and
district nurse.
At the home conference (Ti). the GP
and district nurse were given a short
questionnaire. A second, partly
different questionnaire was sent to
them one month later (T2).
NOS Cross-
sectional: 3/5
(not all
elements of
assessment
relevant).
General practitioners (GPs) and
palliative care: Perceived tasks
and barriers in daily practice
Groot,70 2005
The Netherlands
Qualitative
Aim: to investigate GPs' task
perception and barriers involved
in palliative care
Setting: General practice
Participants: 3 focus groups of GPs, The
size of the groups varied from four to
eleven.
Focus group interviews to discuss the
tasks and barriers encountered in
providing palliative care.
Systematic content analysis was
performed
CASP 9/10
Supplementary material BMJ Support Palliat Care
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Palliative care provided by GPs:
The carer's viewpoint
Hanratty,22 2000
United Kingdom
Cross sectional
Aim: to explore bereaved carers'
views of the palliative care
provided by GPs
Setting: General practice
Participants: Bereaved carers who
registered a patient death from cancer in
a North Yorkshire district. 139/234 carers
who had registered a death from cancer
Postal survey using: the VOICES
survey and demographic questions
NOS Cross-
sectional: 5/5
(not all
elements of
assessment
relevant).
Doctors' perceptions of
palliative care for heart failure:
Focus group study
Hanratty,59 2002
United Kingdom
Qualitative
Aim: To identify doctors'
perceptions of the need for
palliative care for heart failure
and barriers to change
Setting: UK multiple specialties
Participants: Seven focus groups of
doctors including two GP groups. (10
GPs, 8 male)
Focus groups CASP 9/10
Palliative care referral practices
and perceptions: The divide
between metropolitan and non-
metropolitan general
practitioners.
Johnson,67 2011
Australia
Cross-sectional
Aim: To assess GPs' perceptions
and specialist palliative care
referral practice for their patients
with advanced cancer and
differences between
metropolitan and non-
metropolitan GPs.
Setting: Australian General practice
Participants: Stratified random sample of
1680 Australian GPs in different
geographic settings
Postal questionnaire NOS Cross-
sectional
7/10
Information transfer to out-of-
hours co-operatives: a survey of
general practitioners' views in
relation to palliative patients
Kiely, 50 2013
Ireland
Cross-sectional
Aim: (A) Assess views of GPs on
the importance of developing a
formalised method of information
transfer,(B) Assess the type of
information consider important or
necessary (C) describe perceived
current barriers to care provision
for PC patients and (D) to provide
an evidence base to develop an
electronic palliative care summary
Setting: GPs registry in the Irish Medical
Directory in the southwest of Ireland.
Participants: Questionnaire sent to 414
GPs. 214 (52% of the 414) responded to
the survey.
Postal questionnaire with stamped
addressed envelope. A reminder was
sent.
NOS Cross-
sectional:
7/10
Supplementary material BMJ Support Palliat Care
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'Now nobody falls through the
net': Practitioners' perspectives
on the Gold Standards
Framework for community
palliative care
King,62 2005
United Kingdom
Qualitative study.
Aim: A) to explore experiences of
key members of the primary
health care team in practices
implementing the GSF
B) to examine how the GSF
framework was integrated into
the daily life of a practice
C) to examine whether
practitioners saw it as succeeding
in meeting their aspirations for
community palliative care
Setting: General practice and home in
four separate geographical areas in
Scotland and the Nth of England
Participants: Two practices using GSF and
two practices not using GSF in each of the
4 areas (15 practices in total). 68
Gps, district nurses and practice staff
from these 15 practices were
interviewed.
Telephone interview using semi-
structured interview guide including
questions focusing on the 7c's of GSF.
Thematic analysis was used. Using
three levels of matrices. First a matrix
for each practice, then condensed at
an area level. Finally, a comparative
matrix looking at differences between
GSF and nonm-GSF practices.
CASP 9/10
Inter-professional relationships
and communication in primary
palliative care: Impact of the
Gold Standards Framework
Mahmood-Yousuf,63 2008
United Kingdom
Qualitative interview case study
Aim: to evaluate current PC
knowledge of rural GPs And
nurses, learning needs of both and
access to PC information and
services
Setting: General practices from three
primary care trusts in England.
Participants: n= 38 GPs, district nurses,
Macmillan nurses, and framework
facilitators from 15 practices
Semi-structured interviews around
communication between
professionals about terminally ill
patients and teamwork in delivering
care.
Contacted by letter and then a follow
up phone call.
Analysis - matrix analysis - matrix cells
were populated with relevant text
from interviews.
CASP
Qualitative:
8/10
Coordination of care for
individuals with advanced
progressive conditions: A multi-
site ethnographic and serial
interview study
Mason,23 2013
United Kingdom
Qualitative
Aim: to identify how and what
extent end of life care is
coordinated in generalist care.
Setting: Generalist clinical settings
producing three parallel case studies: an
acute admissions unit in a regional
hospital, a large general practice, and a
respiratory outpatient service.
Participants: 3 UK generalist clinical
settings.
A total of 56 patients, 25 family carers
and 17 clinicians yielded 198 interviews.
Ethnographic observations in each
setting were conducted for 22 weeks.
followed by semi-structured
interviews. Interviews every 8-12
weekly intervals with patients and or
carer and single interviews with
health professionals
CASP
Qualitative:
9/10
Supplementary material BMJ Support Palliat Care
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Care of the haematology patient
and their family: the GP
viewpoint
McGrath,66 2007
Australia
Design: Qualitative
Aim: To examine the GP role in
a model of care for haematology
that extends to bereavement.
Setting: Australian medical practice
Participants: 96 health professionals
involved in the care of people with
haematological malignancy, including 2
GPs
Open ended interviews, thematic
analysis
CASP 3/10
General practitioner attitudes to
case conference: How can we
increase participation and
effectiveness?
Mitchell,68 2002
Australia
Qualitative
Aim: to exploring attitudes and
barriers to case conferencing for
GP's
Setting: General practices in
metropolitan, regional and rural
Australia
Participants: 29 GPs
Exploratory semi-structured
interviews. Analysis type not
specified
CASP
Qualitative:
5/10
GP case conferences- lessons
learned.
56 Case conferences
Mitchell,69 2005
Australia
Design: Telephone interviews
Aim: To describe the utility and
acceptability to general
practitioners and palliative care
staff of case conferences in
palliative care
Design: Telephone interviews
Participants: 52 GPs who participated in
56 Case conferences
Qualitative study CASP
8/10
Do case conferences between
general practitioners and
specialist palliative care services
improve quality of life? A
randomised controlled trial
(ISRCTN 52269003)
Mitchell,42 2008
Australia
RCT
Aim: Do case conferencing
improve QOL for palliative care?
Setting: General practice and hospital
Intervention: case conference vs usual
care
Participants: 159 palliative care patients.
A multi-centred randomised
controlled trial of specialist- GP case
conferences, with the GP
participating by teleconference, or
usual care and communication
methods.
An intention-to-treat analyses were
conducted using recruitment, and
time of death, as fixed time points.
JDAD: 3/8
.
Supplementary material BMJ Support Palliat Care
doi: 10.1136/bmjspcare-2019-002109–11.:10 2020;BMJ Support Palliat Care, et al. Rhee JJ
Case conferences between
general practitioners and
specialist teams to plan end of
life care of people with end
stage heart failure and lung
disease: an exploratory pilot
study
Mitchell,43 2014
Australia
Controlled before and after
Aim: to assess the effectiveness of
case conferences between
specialist teams and GP in
improving patient outcomes for
people with end stage heart
failure or lung disease.
Setting: General practice
Intervention: Case conference between
GP, palliative care physician and case
management nurse.
Participants: Twenty-three case
conferences involving 21 GPs were
conducted between November 2011 and
November 2012
Rates of service utilisation
(emergency department [ED]
presentations, ED discharges back to
home, hospital admissions, and
admission length of stay) before and
after case conference were calculated
NOS Cohort
4/5 (not all
elements of
assessment
relevant).
Providing end-of-life care in
general practice: findings of a
national GP questionnaire
survey
Mitchell,47. 2016
United Kingdom
Web survey – Qualitative analysis
of free text questions
Aims: Describe-
What is the current experience of
GPs delivering EOLC?
What barriers and facilitators do
they identify to the provision of
EOLC?
Setting:
General practitioners responding to a
national online survey.
Participants: 516 GPs widely distributed
through England, some from Scotland
and Wales.
Questionnaire with free text
responses
CASP
Qualitative
8/10
Facilitating good process in
primary palliative care: Does the
Gold Standards Framework
enable quality performance?
Munday,61 2007
United Kingdom
Qualitative
Aim: to explore the effectiveness
and sustainability of the
implementation of Gold
Standards Framework at practice
level.
Setting: General practices in
metropolitan, regional and rural UK
Participants: 15 practices, comprising of
45 interviews
Semi-structured interviews and
matrix analysis
NOS Cross-
sectional:
8/10
Supplementary material BMJ Support Palliat Care
doi: 10.1136/bmjspcare-2019-002109–11.:10 2020;BMJ Support Palliat Care, et al. Rhee JJ
Shared care in basic level
palliative home care:
Organizational and
interpersonal challenges
Neergaard,73 2010
Denmark
Qualitative
Aim: to analyse health
professionals’ views on inter-
professional cooperation in basic
level palliative home care for
terminally ill cancer patients.
Setting: General practices
Participants: A total of 43 health
professionals (23 family physicians, 5
chief physicians, and 15 home care
nurses) were included in 7 semi-
structured group interviews.
Exploratory qualitative focus groups CASP
Qualitative:
6/10
Rural palliative care needs: a
survey of primary care
professionals in Powys, Wales.
Noble,64 2001
United Kingdom
Design: Postal survey
Aim: To assess a new, coordinated
framework for the commissioning
of specialist cancer and palliative
care services and an educational
intervention to raise the
standards of generalist palliative
care.
Setting: Geographically large, sparsely
populated county in Wales consisting
of several district communities with no
district general hospital.
Participants: GPs in Powys, Macmillan
GPCFs (general practitioner clinical
facilitator), and district nurses working as
part of primary health care based in GP
practices and charge nurses and sisters
working on community hospital wards
where palliative care is provided.
Post survey. Mixed response
type: alternatives, Likert, free text.
CASP 6/10
General practitioners’ attitudes
to palliative care: a Western
Australian rural perspective.
O’Connor,32 2006
Australia
Design: Semi-structured
interview.
Aim: To understand GPs’ attitudes
to palliative care in rural WA, what
factors contribute to GPs
attitudes to palliative care in rural
WA and what are the perceived
barriers to the provision of
palliative care in rural WA.
Setting: Rural WA.
Participants: 10 registered GPs located
within the Greater Bunbury Division of
General Practice. 8 Males, 2 females.
Semi-structured interview, open-
ended questions.
CASP 9/10
Supplementary material BMJ Support Palliat Care
doi: 10.1136/bmjspcare-2019-002109–11.:10 2020;BMJ Support Palliat Care, et al. Rhee JJ
The role of primary care
physicians in advanced cancer
care: Perspectives of older
patients and their oncologists
O'Toole,30 2009
USA
RCT and Cross sectional
Aim: to identify age- related
differences in patient and
oncologist perspectives on
involvement of GPs
Setting: Teaching hospital-based cancer
clinics
Participants: 39 oncologists and 357
Patients who had an oncologist and PCP
enrolled 2 to 3 months after an advanced
cancer diagnosis
Survey - demographics and attitudes
to involvement of GP in ongoing care.
Patients were already part of a RCT
looking at a support intervention.
NOS Cross-
sectional:
2/10 (not all
elements of
assessment
relevant)
What influences the willingness
of community physicians to
provide palliative care for
patients with terminal cancer?
Evidence from a nationwide
survey
Peng,40 2013
Taiwan
Cross sectional
Aim: A) to identify community
physicians’ willingness to provide
palliative care in their
communities when they
encounter patients with terminal
cancer and B) to investigate the
factors that influence their
willingness to provide palliative
care.
Setting: General practices in
metropolitan, regional and rural Taiwan
Participants: 708 community physicians
who were potential pilots to provide
palliative care. Four hundred and ten
valid questionnaires (58.0%) were
retrieved and analysed.
Structured questionnaire NOS Cross
sectional 6/9
An insight into the delivery of a
palliative approach in
residential aged care: The
general practitioner
perspective.
Phillips55 2009
Australia
Design: Qualitative study
Aim: To investigate GP’s
perceptions and
understanding of a
palliative approach in
residential aged care.
Setting: Australian general practice
Participants: Convenience sample of
Thirteen GPs
Qualitative – Focus groups CASP
8/10
Improving generalist end of life
care: National consultation with
practitioners, commissioners,
academics, and service user
groups
Shipman,46 2008
Qualitative
Aim: to identify major concerns in
the commissioning, provision,
research and use of generalist end
of life care
Setting: Primary and secondary care,
specialist palliative care, and academic
and voluntary sectors in England and
Scotland.
Participants: Healthcare practitioners,
commissioners, academics, and
representatives of user and voluntary
Qualitative approach: a national
consultation and prioritising exercise
using a modified form of the nominal
group technique.
CASP
Qualitative:
8/10
Supplementary material BMJ Support Palliat Care
doi: 10.1136/bmjspcare-2019-002109–11.:10 2020;BMJ Support Palliat Care, et al. Rhee JJ
United Kingdom groups. 74% of those invited (210/285)
participated.
End-of-life care from the
perspective of primary care
providers
Silviera,51 2012
USA
Qualitative
Aim: to explore the factors
influencing primary care
providers' ability to care for their
dying patients in Michigan
Setting: Primary care practices in
southeast Michigan.
Participants: 28 primary care
practitioners and 22 clinical support staff
from by 7 diverse primary care practices
16 focus groups to explore the
provision of end-of-life care
Interviews were analyzed using
thematic analysis.
CASP
Qualitative:
10/10
Palliative Care Partnership: a
successful model of
primary/secondary integration
Stewart,76
2006
New Zealand
Qualitative
Aim: to assess outcomes of an
integration project between GPs
and palliative care
Setting: General practice
Participants: Practices and GPS, not clear
how many were surveyed or responded.
Survey and patient record
Qualitative comments regarding
communication and linkages from a
successful model – a model of
integration that combine
participation framework, education
program, and partnership
administration and governance
group.
CASP
Qualitative:
1/10
Out-of-hours GPs and palliative
care – a qualitative study
exploring information exchange
and communication issues.
Taubert,65 2010
UK
Design: In-depth, semi-structured
interviews.
Aim: Explore factors that they
(out-of-hours GPs) identified as
detrimental or beneficial for good
communication between
themselves, patients, relatives
and other professionals,
specifically to palliative care
encounters.
Setting: GPs working with a privately
contracted out-of-hours primary care
provider in Cardiff, UK.
Participants: 9 GPs agreeing out of 60 GPs
contacted.
In-depth, semi-structured interviews. CASP 10/10
PaTz groups for primary
palliative care: reinventing
cooperation between general
practitioners and district nurses
in palliative care: an evaluation
study combining data from
Cross sectional, and qualitative
Aim: to explore experiences of
collaboration between general
practitioners and district nurses,
and perceived benefits of and
Setting: Primary care
Participants: 24 general practitioners
completed a survey questionnaire.
7 GPs, 5 district nurses and 2 PC
consultants attended focus groups.
A survey questionnaire and focus
group discussion
CASP
Qualitative:
8/10
NOS Cross-
sectional:
Supplementary material BMJ Support Palliat Care
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focus groups and a
questionnaire
van der Plas,71 2014
Netherlands
barriers for implementation of
PaTz (PC at home).
4/5 (not all
elements of
assessment
relevant).
Involvement of the practice
nurse in supporting older people
with heart failure: GP
perspectives.
Waterworth,75 2012
New Zealand
Design: In-depth, semi-
structured interviews.
Aim: Explore views of GPs
regarding involvement of practice
nurse (PN) in supporting older
people with heart failure
throughout disease trajectory.
Identify specific implications for
initiating advance care planning
and improving end-of-life care.
Setting: Urban New Zealand (Auckland).
Participants: 30 GPs from a range of GP
practices (representing
different practice demographics).
In-depth telephone interviews, semi-
structured.
CASP 8/10
3.6 Availability of GP and GPN services
Palliative care by family
physicians in the 1990s.
Resilience amid reform
Burge,21 2001
Canada
Qualitative
Aim: to ascertain Family physician
perceptions of providing palliative
care in context of shrinking
hospital resources.
Setting: College of Physicians and
Surgeons, Nova Scotia.
Purposive sampling. 5 focus groups with
25 male and female GPs.
Focus groups
Audiotaped and transcribed
Thematic analysis
CASP 8/10
Supplementary material BMJ Support Palliat Care
doi: 10.1136/bmjspcare-2019-002109–11.:10 2020;BMJ Support Palliat Care, et al. Rhee JJ
Understanding the provision of
palliative care in the context of
primary health care: Qualitative
research findings from a pilot
study in a community setting in
Chile.
Cameron,27 2009
Chile
Design: Hermeneutic
phenomenology
Aim: Understand the provision of
palliative care in the context of
primary health care (PHC).
Examine the PHC milieu as
a propitious one in which to
provide palliative care in a
developing country. Generate
opportunities for international
collaboration with Chile in areas
of public health, nursing and
palliative care.
Setting: PHC centres in
the Chiguayante district, Chile.
Population served – 33,000. Majority
low-income demographic.
Participants: 3 adults receiving palliative
care through the PHC, 2 family members,
2 PHC professionals (1 physician, 1
nurse).
Unstructured face-to-face interviews
and observation of patients and their
families as well as doctors and
practice nurses.
CASP
10/10
Developing a framework for
primary palliative care services.
Daniels,58 2001
United Kingdom
Design: Mixed methods design
Aim: to evaluate current care
provision and explore methods of
developing palliative care services
in general practice.
Setting: Single urban general practice
Participants: 21 team members
associated with the general practice, 22
patients and their carers identified from
a records search.
Phase one: multiple team meetings
Phase two: questionnaires and
individual interviews with team
members to facilitate critical thinking
about palliative care service
provision.
CASP
9/10
Reasons for hospitalisation at
the end of life: Differences
between cancer and non-cancer
patients
De Korte-Verhoef,19 2014
Netherlands
Cross-sectional
Patients of participating GPs who
died of either cancer or non-
malignant disease and were
hospitalised within 3 months of
death.
Setting:Dutch general practice
Participants: 317 Deceased patients of
Dutch GPs
Patients identified from retrospective
reporting from a network of GPs, who
died and had been hospitalised within
3 months of death.
NOS Cross
Sectional
5/10
Factors enabling shared care
with primary healthcare
providers in community
settings: The experiences of
Design: Case study. Semi-
structured focus groups. Adapted
thematic content analysis.
Setting: Southern Ontario, Canada, Local
Health Integration Networks (LHIN).
Participants: 5 palliative care teams
consisting of student learners on
Semi-structured focus groups and
interviews.
CASP 8/10
Supplementary material BMJ Support Palliat Care
doi: 10.1136/bmjspcare-2019-002109–11.:10 2020;BMJ Support Palliat Care, et al. Rhee JJ
interdisciplinary palliative care
teams.
DeMiglio,39. 2012
Canada
Aim: Examine how palliative care
teams negotiate barriers in order
to share mutual responsibility for
patients with primary healthcare
providers
rotation, community nurses and the
clinicians themselves.
Shared care: The barriers
encountered by community-
based palliative care teams in
Ontario, Canada
DeMiglio,72 2012
Canada
Qualitative
Aim: to explore barriers to views
and experiences of community
based palliative care teams about
facilitators and barriers to shared
care with community based
primary care teams.
Setting: community-based palliative care
Participants: five community-based
palliative care teams and six key-
informants
Thematic analysis.
Synthesis of data using a 3-I
framework,
CASP 8/10
Experiences, knowledge and
opinions on palliative care
among Romanian general
practitioners.
Dumitrescu,77 2005
Romania
Design: Multi-choice
questionnaire – self assessment.
Aim: Assess experience,
knowledge and opinions of
Romanian GPs on palliative
healthcare in Romania.
Setting: 5 districts of Romania which
were representative of the nation in
areas of male/female ratio and death
rate. The authors noted that the
urban/rural proportion in the districts
chosen was not representative of the
nation.
Participants: 1283 general practitioners,
71% response rate.
Multi-choice questionnaires CASP 7/10
Cancer Patients Use Hospital-
Based Care Until Death: A
Further Analysis of the Dutch
Bone Metastasis Study
Meeuse,54 2011
Netherlands
Design: Cross-sectional
study) Multiple Questionnaires d
uring RCT of radiation therapy for
bony metastases
Aim: To describe health
care utilization in cancer
patients with bony metastases,
and independent predictors
for that utilisation
Setting: Dutch Oncology and community
service providers
Participants: 661/860 (77%) potential
respondents
Multilevel logistic regression. NOS Cross-
Sectional
10/10
Supplementary material BMJ Support Palliat Care
doi: 10.1136/bmjspcare-2019-002109–11.:10 2020;BMJ Support Palliat Care, et al. Rhee JJ
Providing end-of-life care in
general practice: findings of
a national GP questionnaire
survey
Mitchell,47 2016
United Kingdom
Web survey – Qualitative analysis
of free text questions
Aims: Describe-
What is the current experience of
GPs delivering EOLC?
What barriers and facilitators do
they identify to the provision of
EOLC?
Setting:
General practitioners responding to a
national online survey.
Participants: 516 GPs widely distributed
through England, some from Scotland
and Wales.
Questionnaire with free text
responses
CASP
Qualitative
8/10
Rural palliative care needs: a
survey of primary care
professionals in Powys, Wales.
Noble,64 2001
United Kingdom
Design: Postal survey
Aim: To assess a new, coordinated
framework for the commissioning
of specialist cancer and palliative
care services and an educational
intervention to raise the
standards of generalist palliative
care.
Setting: Geographically large, sparsely
populated county in Wales consisting
of several district communities with no
district general hospital.
Participants: GPs in Powys, Macmillan
GPCFs (general practitioner clinical
facilitator), and district nurses working as
part of primary health care based in GP
practices and charge nurses and sisters
working on community hospital wards
where palliative care is provided.
Post survey. Mixed response
type: alternatives, Likert, free text.
CASP 6/10
General practitioners’
experience of bereavement care
and their educational support
needs.
O’Connor,33 2014
Australia
Design: Semi-structured
interview.
Aim: to explore GPs’
understandings of bereavement
support and their educational
and professional development
needs in relation to providing
bereavement care.
Setting: Australian general practice
Participants: 19 WA GPs (12 female)
Semi-structured interviews CASP 9/10
An insight into the delivery of a
palliative approach in
residential aged care: The
Design: Qualitative study
Setting: Australian general practice
Qualitative – Focus groups CASP
8/10
Supplementary material BMJ Support Palliat Care
doi: 10.1136/bmjspcare-2019-002109–11.:10 2020;BMJ Support Palliat Care, et al. Rhee JJ
general practitioner
perspective.
Phillips,52 2009
Australia
Aim: To investigate GP’s
perceptions and
understanding of a
palliative approach in
residential aged care.
Participants: Convenience sample of
Thirteen GPs
Attitudes and barriers to
involvement in palliative care by
Australian urban general
practitioners.
Rhee,35 2008
Australia
Design: Cross-sectional
Aim: To determine the level of
participation of Australian urban
GPs in palliative care and to
determine the main barriers
facing them in providing this care.
Setting: Sydney, Australia. 50% of surveys
sent to lower socioeconomic (SES) areas
and 50% sent to higher SES areas of
Sydney.
Participants: 500 GPs sent surveys. 269
returned.
Cross sectional postal survey.
Questions formulated with a panel of
experts in palliative care or GPs with
special interests in palliative care.
CASP 10/10
Palliative care provision by rural
general practitioners in New
Zealand.
Smyth,78 2010
New Zealand
Design: Cross-sectional postal
survey
Aim: Ascertain the workload for
rural general practitioners
providing palliative care and to
identify barriers to care for
patients living in rural areas of
New Zealand.
Setting: Rural New Zealand.
Participants: GPs working in rural areas of
NZ. 186 responses (42.2% response rate).
Postal survey, questions adapted
from literature.
CASP 7/10
Out-of-hours GPs and palliative
care – a qualitative study
exploring information exchange
and communication issues.
Taubert,65 2010
United Kingdom
Design: In-depth, semi-structured
interviews.
Aim: Explore factors that they
(out-of-hours GPs) identified as
detrimental or beneficial for good
communication between
themselves, patients, relatives
and other professionals,
specifically to palliative care
encounters.
Setting: GPs working with a privately
contracted out-of-hours primary care
provider in Cardiff, UK.
Participants: 9 GPs agreeing out of 60 GPs
contacted.
In-depth, semi-structured interviews. CASP 10/10
Supplementary material BMJ Support Palliat Care
doi: 10.1136/bmjspcare-2019-002109–11.:10 2020;BMJ Support Palliat Care, et al. Rhee JJ
Involvement of the practice
nurse in supporting older people
with heart failure: GP
perspectives.
Waterworth,75 2012
Design: In-depth, semi-
structured interviews.
Aim: Explore views of GPs
regarding involvement of practice
nurse (PN) in supporting older
people with heart failure
throughout disease trajectory.
Identify specific implications for
initiating advance care planning
and improving end-of-life care.
Setting: Urban New Zealand (Auckland).
Participants: 30 GPs from a range of GP
practices (representing
different practice demographics).
In-depth telephone interviews, semi-
structured.
CASP 8/10
3.7 Specific circumstances
Palliative care for older people –
exploring the views of doctors
and nurses from different fields
in Germany
Brueckner,49 2009
Germany
Qualitative
Aim: to explore various health
providers' perceptions
and atti- tudes concerning the
delivery of palliative care to older
persons in Germany.
Setting: Geriatric institutions and
referring GPs in Hannover, Germany
Participants: Twenty-nine participants in
seven focus groups (general
practitioners, geriatricians, palliative care
physicians, palliative care nurses and
general nurses).
Qualitative, focus groups CASP
9/10
Palliative care by family
physicians in the 1990s.
Resilience amid reform
Burge,21 2001
Canada
Qualitative
Aim: to ascertain Family physician
perceptions of providing palliative
care in context of shrinking
hospital resources.
Setting: College of Physicians and
Surgeons, Nova Scotia.
Purposive sampling. 5 focus groups with
25 male and female GPs.
Focus groups
Audiotaped and transcribed
Thematic analysis
CASP 8/10
Supplementary material BMJ Support Palliat Care
doi: 10.1136/bmjspcare-2019-002109–11.:10 2020;BMJ Support Palliat Care, et al. Rhee JJ
Understanding the provision of
palliative care in the context of
primary health care: Qualitative
research findings from a pilot
study in a community setting in
Chile.
Cameron,27 2009
Chile
Design: Hermeneutic
phenomenology
Aim: Understand the provision of
palliative care in the context of
primary health care (PHC).
Examine the PHC milieu as
a propitious one in which to
provide palliative care in a
developing country. Generate
opportunities for international
collaboration with Chile in areas
of public health, nursing and
palliative care.
Setting: PHC centres in
the Chiguayante district, Chile.
Population served – 33,000. Majority
low-income demographic.
Participants: 3 adults receiving palliative
care through the PHC, 2 family members,
2 PHC professionals (1 physician, 1
nurse).
Unstructured face-to-face interviews
and observation of patients and their
families as well as doctors and
practice nurses.
CASP
10/10
Involvement of general
practitioners in palliative cancer
care: A qualitative study
Dahlhaus,31 2013
Germany
Qualitative
Aim: to explore general
practitioners' perceptions of their
involvement in palliative cancer
care and the constraints they
confront
Setting: General Practice
Participants: Purposive sampling. 13 GPS
Qualitative interview schedule asking
open ended questions about last
palliative patient they had cared for.
Analysis: qualitative content analysis
according to Mayring
CASP 9/10
General practitioners'
perspectives on the avoidability
of hospitalizations at the end of
life
De Korte-Verhoef,18 2014
Netherlands
Sequential Mixed methods design
Aim: To explore GP views on
whether and how hospitalizations
could have been avoided in the
last 3 months of life and barriers
to avoid this.
Setting: Netherlands GPs
Participants: 319 GPs who had a non-
acute death. In-depth interviews wwith
18 GPs
National cross-sectional design, then
in depth Qualitative interviews.
NOS Cross-
sectional
4/9
Experiences, knowledge and
opinions on palliative care
among Romanian general
practitioners.
Design: Multi-choice
questionnaire – self assessment.
Aim: Assess experience,
knowledge and opinions of
Setting: 5 districts of Romania which
were representative of the nation in
areas of male/female ratio and death
rate. The authors noted that the
urban/rural proportion in the districts
Multi-choice questionnaires CASP 7/10
Supplementary material BMJ Support Palliat Care
doi: 10.1136/bmjspcare-2019-002109–11.:10 2020;BMJ Support Palliat Care, et al. Rhee JJ
Dumitrescu,77 2005
Romania
Romanian GPs on palliative
healthcare in Romania.
chosen was not representative of the
nation.
Participants: 1283 general practitioners,
71% response rate.
Care of the haematology patient
and their family: the GP
viewpoint
McGrath,66 2007
Australia
Design: Qualitative
Aim: To examine the GP role in
a model of care for haematology
that extends to bereavement.
Setting: Australian medical practice
Participants: 96 health professionals
involved in the care of people with
haematological malignancy, including 2
GPs
Open ended interviews, thematic
analysis
CASP 3/10
Rural palliative care needs: a
survey of primary care
professionals in Powys, Wales.
Noble,64 2001
United Kingdom
Design: Postal survey
Aim: To assess a new, coordinated
framework for the commissioning
of specialist cancer and palliative
care services and an educational
intervention to raise the
standards of generalist palliative
care.
Setting: Geographically large, sparsely
populated county in Wales consisting
of several district communities with no
district general hospital.
Participants: GPs in Powys, Macmillan
GPCFs (general practitioner clinical
facilitator), and district nurses working as
part of primary health care based in GP
practices and charge nurses and sisters
working on community hospital wards
where palliative care is provided.
Post survey. Mixed response
type: alternatives, Likert, free text.
CASP 6/10
General practitioners’ attitudes
to palliative care: a Western
Australian rural perspective.
O’Connor,32 2006
Australia
Design: Semi-structured
interview.
Aim: To understand GPs’ attitudes
to palliative care in rural WA, what
factors contribute to GPs
attitudes to palliative care in rural
WA and what are the perceived
barriers to the provision of
palliative care in rural WA.
Setting: Rural WA.
Participants: 10 registered GPs located
within the Greater Bunbury Division of
General Practice. 8 Males, 2 females.
Semi-structured interview, open-
ended questions.
CASP 9/10
Supplementary material BMJ Support Palliat Care
doi: 10.1136/bmjspcare-2019-002109–11.:10 2020;BMJ Support Palliat Care, et al. Rhee JJ
An insight into the delivery of a
palliative approach in
residential aged care: The
general practitioner
perspective.
Phillips,52 2009,
Australia
Design: Qualitative study
Aim: To investigate GP’s
perceptions and
understanding of a
palliative approach in
residential aged care.
Setting: Australian general practice
Participants: Convenience sample of
Thirteen GPs
Qualitative – Focus groups CASP
8/10
Palliative care provision by rural
general practitioners in New
Zealand.
Smyth,78 2010
New Zealand
Design: Cross-sectional postal
survey
Aim: Ascertain the workload for
rural general practitioners
providing palliative care and to
identify barriers to care for
patients living in rural areas of
New Zealand.
Setting: Rural New Zealand.
Participants: GPs working in rural areas of
NZ. 186 responses (42.2% response rate).
Postal survey, questions adapted
from literature.
CASP 7/10
Finding common ground to
achieve a “good death”: family
physicians working with
substitute decision-makers of
dying patients. A qualitative
grounded theory study.
Tan,57 2013
Canada
Design: Qualitative
Aim: to describe Canadian family
physicians’ experiences of conflict
with substitute decision-makers
of dying patients to identify
factors that may facilitate or
hinder the end-of-life decision-
making process.
Setting: Edmonton, Canada
Participants: Purposive sample of eleven
urban GPs
Individual semi-structured
interviews, Analysis using Grounded
theory methodology.
CASP
9/10
GP and nurses' perceptions of
how after hours care for people
receiving palliative care at home
could be improved: a mixed
methods study
Tan,44 2009
Australia
Design: Cross-sectional survey
Aim: To identify barriers to the
provision of after-hours palliative
Care in Australian general
practice.
Setting: three Divisions of General
Practice (one each of urban, regional
and rural areas)
Participants: 114/524 (22%) GPs and
52/112 (43%) community nurses
Questionnaire based on
previous qualitative study.
NOS Cross-
sectional
2/5 (not all
elements of
assessment
relevant).
Supplementary material BMJ Support Palliat Care
doi: 10.1136/bmjspcare-2019-002109–11.:10 2020;BMJ Support Palliat Care, et al. Rhee JJ
Out-of-hours GPs and palliative
care – a qualitative study
exploring information exchange
and communication issues.
Taubert,65 2010
United Kingdom
Design: In-depth, semi-structured
interviews.
Aim: Explore factors that they
(out-of-hours GPs) identified as
detrimental or beneficial for good
communication between
themselves, patients, relatives
and other professionals,
specifically to palliative care
encounters.
Setting: GPs working with a privately
contracted out-of-hours primary care
provider in Cardiff, UK.
Participants: 9 GPs agreeing out of 60 GPs
contacted.
In-depth, semi-structured interviews. CASP 10/10
1 CASP: Critical Appraisal Skills Programme qualitative checklist http://media.wix.com/ugd/dded87_29c5b002d99342f788c6ac670e49f274.pdf
2 NOS: Newcastle-Ottawa Scale Cross-sectional: This scale was adapted from the Newcastle-Ottawa Quality Assessment Scale for cohort studies by Herzog R et al , BMC
Public Health201313:154. DOI: 10.1186/1471-2458-13-154
3 NOS: Newcastle-Ottawa Scale Case-control: http://www.ohri.ca/programs/clinical_epidemiology/nos_manual.pdf
4 NOS: Newcastle-Ottawa Scale Cohort: http://www.ohri.ca/programs/clinical_epidemiology/nos_manual.pdf
Supplementary material BMJ Support Palliat Care
doi: 10.1136/bmjspcare-2019-002109–11.:10 2020;BMJ Support Palliat Care, et al. Rhee JJ