improving the care of the caregivers of general practice ... · b. palliative care services...
TRANSCRIPT
www.uq.edu.au/health "Sustainable Development in Primary Care”
The Discipline of General Practice
Improving the care of the caregivers of palliative care patients: randomized controlled trial of the Caregiver Needs Assessment Tool
Geoffrey Mitchell1, Afaf Girgis2,3, Moyez Jiwa4,
David Sibritt3, Letitia Burridge1
1.University of Queensland, Brisbane, Australia
2.Centre for Health Research and Psycho-oncology
3.Newcastle University, Newcastle, Australia 4.Curtin University, Perth Australia
www.uq.edu.au/health "Sustainable Development in Primary Care”
The Discipline of General Practice
Pa#entswithadvancedcancerareveryillandaretheunderstandablefocusofa6en#onofhealthprofessionals.
MosthaveCaregiverswhoalsohaveneedsarisingfromtheburdenofcaring,andpre‐exis#nghealthandsocialneeds.
Caregiverexhaus#onisamajorcauseofhospitalisa#onofpa#ents,andmayleadtothepa#entdyingawayfromhomewherethisisnotthepa#ent’swish.
www.uq.edu.au/health "Sustainable Development in Primary Care”
The Discipline of General Practice
Who cares for Caregivers?
Patients – Oncologist, Radiation oncologists, surgeons, palliative care, GPs
Caregivers – informal arrangements
Hypothesis:
That caregiver needs, if addressed by their GP, improve their outcomes compared to normal care.
www.uq.edu.au/health "Sustainable Development in Primary Care”
The Discipline of General Practice
Trial design
Randomised controlled trial of the Needs Assessment Tool- Caregivers (NAT-C) and supporting documentation vs normal care
www.uq.edu.au/health "Sustainable Development in Primary Care”
The Discipline of General Practice
What the NAT-C should contain
Questions on:
• Information for the caregiver,
• Practical caring,
• Personal health and wellbeing,
• Relationships with the patient and significant others,
• Issues around meaning and identity
www.uq.edu.au/health "Sustainable Development in Primary Care”
The Discipline of General Practice
Desirable qualities of a potential tool
Caregivers GPs OtherHPs
Basic,simpleformat Keepitsimple Short
Non‐jargon,simple Non‐technical Non‐clinicallanguage
Spaceforcomments
Explanatoryintroduc#on
Briefexplana#on Conveyvalue
Goodpreamble
AbletobediscussedwithGP TalkingtoGPmoreimportant
TalkingtoGPmoreimportant Useasaprocessover#me
Useasframeworkfordiscussion Useformasaprocess
“Fillingoutaformisnotgoingtowork…[but]itcouldtaketheformofa listofareasthatmaybethecaregiverwouldwanttotalktothedoctorabout”[GP,1118,p.9].
www.uq.edu.au/health "Sustainable Development in Primary Care”
The Discipline of General Practice
Trial Design- Efficacy Trial
Patients are provided the NAT-C and ask for a long appointment with their GP .
Research staff visit the GP to familiarise them with the NAT-C. Also provide them with a kit that provides resources to meet likely patient need.
Second appointment and NAT-C at three months (accounts for likely rapid change in needs)
Data collection at 0,1,3,6 months.
www.uq.edu.au/health "Sustainable Development in Primary Care”
The Discipline of General Practice
NAT-C
www.uq.edu.au/health "Sustainable Development in Primary Care”
The Discipline of General Practice
Recruitment strategy- 520 patients
Where do caregivers congregate?? a. Oncology clinics b. Palliative care services
Different approaches to patients depending on local requirements a. Approach the caregivers in the clinic waiting
area b. Research officers in a unit identify and approach
carers at the time of treatment. c. Patients at time of referral to a larger palliative
care service assessed by admissions clerk for eligibility.
www.uq.edu.au/health "Sustainable Development in Primary Care”
The Discipline of General Practice
Recruitment Results – 10 weeks
CAREGIVERS Caregivers approached 94 Agreed to participate 54 (5.4 /wk Target 10/wk) Being followed up 9 (67% acceptance) Refused 18 Not Ready 4 Ineligible 4 Not contactable 4
GPs GP - RA visits 14 Refusals 0
www.uq.edu.au/health "Sustainable Development in Primary Care”
The Discipline of General Practice
Attempts to increase recruitment
Further recruitment through largest palliative care service
Another oncology service being added.
www.uq.edu.au/health "Sustainable Development in Primary Care”
The Discipline of General Practice
Dissemination strategy
If proves effective:
Intent to distribute NAT-C through Oncology Clinics