Information about poor prognosis is rarely communicated from secondary to primary care despite this being vital information for GPs, a study has found.
The systematic review of existing research found this was partly due to hospital teams not identifying poor prognosis.
But information sharing was also hindered by not having shared electronic records, the team from Bristol University found.
Details on prognosis were more likely to be shared if death was imminent, the research noted.
Speaking with Pulse, study leader Dr Lucy Pocock, a GP and co-lead of the University of Bristol’s Palliative and End of Life Care Research Group said they were now doing work with clinicians to find out how communication on prognosis could be improved.
The failure to pass on information to general practice about poor prognosis impacts continuity of care and can mean patients have to repeat difficult conversations.
They also often assume the GP knows what has happened in hospital and are frequently shocked to find this is not the case, she said.
Lack of information sharing can also result in suboptimal care for patients towards the end of life, she explained.
In all 30 studies met the criteria for inclusion in the systematic review. It found letters from hospital specialists such as oncology to GPs rarely contained information about prognosis or whether treatment intent was curative or palliative.
The sharing of poor prognosis was also not commonplace in hospital discharge communication, even for patients seen by palliative care teams during their admission, the review published in the British Journal of General Practice found.
Research has also shown that details on prognosis are more likely to be shared between clinicians in face-to-face conversations or phone calls.
And there is high-quality evidence that sharing of this information was more likely to occur when the patient’s case was clinically complex or they were very sick, researchers said.
In the UK, up to one in three people admitted to hospital as an emergency are in the last year of life.
Identifying these patients and communicating this to their GP means they can be offered the opportunity to have advance care planning conversations, and that they are more likely to receive the care that they wish for, in their preferred place, they concluded.
‘We need to understand why that communication between secondary and primary care doesn’t happen and that is the research I am doing in hospital at the moment,’ Dr Pocock said.
‘I’m doing observations, interviewing staff and watching people being discharged. For some people who are in their last year of life, conversations will have happened but very few of them will be documented in the discharge notes. So the GP will have no idea and that makes care very fragmented.’
She said work was needed to better understand the context of conversations around poor prognosis when they did take place but also if there were changes that could be made in terms of prompts or templates in discharge summaries.
‘For the patient it means that they don’t have to have the same conversation repeatedly with different people and it means their care is better. We can talk about where they’d like to be cared for, where they’d like to die, and what’s important to them, but if we don’t know that they’re in the last year of life, we can’t do that.’
“They also often assume the GP knows what has happened in hospital and are frequently shocked to find this is not the case, she said. ”
This is why General Practice as a career is not chosen by so many of those hospital staff – They think they themselves will not be up to learning the skills necessary to be a GP : Omnipotence, Omnipresence, Telepathy, Mind-Reading, and Omni-Translatability ! Of course!