Improving general practitioner involvement in care home End-of-Life care. A systematic literature review and narrative synthesis

Background General Practitioners (GPs) are lead clinicians for palliative and end-of-life care (PEoLC) in residential aged care. Care home residents can experience uncontrolled symptoms, avoidable hospitalisations and difficult deaths at end of life. The evidence about improving GP’s delivery PEoLC in care homes is limited. Aim Systematic review and synthesis about interventions to improve GP-led PEoLC in care homes. Design specialist nurse support enhanced symptom management and reduced hospitalisations; and multidisciplinary rounds improved quality of deaths. Heterogeneity of approach, small sample sizes, unclear clinical population and GP involvement were a challenge for data synthesis. Conclusion Research on the role of GPs in care home PEOLC remains underdeveloped. Findings identified promising improvement strategies and highlighted the challenges for service improvement initiatives. There is real potential for improving the quality of GP PEoLC in care homes.