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 and Setting Systematic review and thematic narrative synthesis of peer-reviewed studies evaluating interventions to improve GP PEoLC care homes. Method Seven databases and grey literature searched to October 2024 using domain terms: GP, Care Homes, and PEoLC. Studies were appraised using Gough’s Weight of Evidence Framework. The review followed PRISMA guidelines and was registered with PROSPERO: CRD42021254141. Results From 5,936 titles, 35 studies were included. Eight papers reported interventions. The robustness of quantitative approaches was weak, limiting external validity and clinical generalizability. Nevertheless the following interventions proved promising: i) Education in PEoLC ii) Specialist palliative care involvement iii) Regular multidisciplinary palliative care meetings Thematic analysis of qualitative data identified how and why interventions worked: education increased advance care planning and staff confidence; 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.