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Table 3 Overview: Wording of measures in both rounds, round of consensus and percentages for relevance and feasibility (FCs = family caregivers, n.c. = no consensus reached, PPC = primary palliative care, GP = general practitioner, ECG = electrocardiography)

From: Improving primary palliative care – a Delphi consensus study on measures for general practice in Germany

 

Final version in round

Round 1 wording

Round 1 relevance [%]

Round 1 feasibility [%]

Round 2 wording

Round 2 relevance [%]

Round 2 feasibility [%]

I. Advance care planning with patients

 M1

2

One selected member from the general practice team conducts a structured first assessment with patients receiving PPC and their FCs.

64.1

57.4

The general practice team conducts a structured first assessment with patients receiving PPC and their FCs.

85.3

76.4

 M2

2

The general practice team develops, in cooperation with patients receiving PPC, an emergency dataset. The dataset is saved in the general practice and/or perspectively on the electronic health card.

78.2

55.6

The general practice team develops, in cooperation with patients receiving PPC, an emergency dataset. The dataset is saved in the general practice and distributed to the patient.

97.0

84.9

 M3

2

GPs identify patients who might benefit from PPC using structured tools (e.g. SPICT).

68.8

75.8

Drawing on their personal experience with the support of structured tools (e.g. the Supportive and Palliative Care Indicators Tool), general practitioners identify patients who might benefit from PPC.

81.8

78.8

 M4

1

A filled in and up-to-date crisis paper sheet is kept clearly visible at the palliative patient’s home (e.g. next to his or her bed).

95.4

91.8

 

 M5

1

The general practice team maintains a copy of each palliative patient’s crisis sheet in the office.

84.1

85.7

II. Consulting and informing patients and FCs

 M6

1

Telephone numbers of emergency contacts and proxies, as selected by the patient, are saved in the practice computer system.

95.3

95.2

 

 M7

2

GPs distribute leaflets with information about palliative care to patients, who could benefit from PPC as well as their FCs.

79.3

83.9

In addition to making personal consultations, GPs distribute leaflets with information about palliative care to patients who could benefit from PPC, as well as their FCs.

85.3

85.3

 M8

2

GPs distribute leaflets with internet resources or information on advance directives and/or health care proxies to patients with a potential palliative disease progression.

71

79

In addition to making personal consultations, GPs distribute leaflets with internet resources or information on advance directives and/or health care proxies to patients with a potential palliative disease progression.

100

97.1

 M9

1

One selected member of the general practice team informs palliative patients about the possibility of a release of confidentiality restraints between involved service providers, to facilitate cooperation and communication between the practice team and other service providers.

76.2

75.4

 

 M10

1

GPs inform all patients and their FCs about the standby service outside of regular practice hours.

76.6

87.1

III. GP office organisation

 M11

1

Physician assistants refill the home visit bag directly after a completed home visit.

80.9

76.6

   

 M12

2

One selected member from the general practice team coordinates the care of patients receiving PPC

68.8

68.8

The general practice team coordinates in joint consultations around the care of patients receiving PPC. If possible/necessary, cooperation with palliative support centres or palliative care teams is initiated.

88.2

85.3

 M13

2

Medical assistants are responsible for updating the medication plans of all patients.

52.3

47.4

GPs are responsible for updating the medication plans of patients receiving PPC and reviewing indications on a regular basis.

97.1

97.0

 M14

n.c.

Continuing education courses offered internally in general practices are made accessible to further cooperating care providers and/or interested parties, such as home health care services and will be actively advertised.

63.5

50.8

Continuing education courses offered internally in general practices are made accessible to further cooperating care providers and/or interested parties, such as home health care services.

64.7

51.5

 M15

1

General practices provide written instructions and options for looking up instructions for rare tasks (e.g. professional association case procedures, rehabilitation requests).

77.8

75.4

 

 M16

1

When registering patients in the general practice, physician assistants ask patients about their preferences, document their complaints and, if necessary, initiate the first treatment steps (e.g. direct the patient to a specific room for ECG).

92.2

91.9

 M17

2

Provide physician assistants with an undisturbed environment for documentation during working hours.

90.6

59.7

If the practice rooms allow it, provide physician assistants with an undisturbed environment for documentation during working hours.

97.1

82.4

 M18

1

The practice team holds regular team meetings.

96.9

92.1

 

 M19

2

For admission requests to hospices or palliative care units, general practice teams use a standardised fax template.

67.2

80.4

For admission requests to hospices or palliative care units, general practice teams use a standardised fax template, which can be supplemented with individual annotations. Where necessary, personal contact is initiated to discuss more complex patients.

91.2

85.3

IV. Continuing education

 M20

1

GPs offer internal courses for their physician assistants on e.g. hygiene standards.

89.0

81.9

 

 M21

1

GPs realize physician assistants’ continuing education requests in a timely manner.

93.7

81.0

 M22

n.c.

Members of the practice team participate in internal courses on palliative care and end-of-life communication.

82.5

72.1

Members of the practice team participate in internal or external courses on palliative care and end-of-life communication.

87.9

69.7

 M23

n.c.

Members of the practice team participate in internal courses on advance directives and advance care planning.

59.3

60.6

Members of the practice team participate in internal or external courses on advance directives and advance care planning.

76.4

67.6

M24

n.c.

Physician assistants accompany GPs on home visits to patients receiving PPC, to gain hands-on practical experience in palliative care.

78.1

61.1

If staffing capacity allows, physician assistants accompany GPs on home visits to patients receiving PPC, to gain hands-on practical experience in palliative care.

91.2

70.6

V. Cooperation with other service providers

 M25

n.c.

Physician assistants complete an internship at a palliative and/or hospice care provider for one month.

57.2

31.2

If staffing capacity allows, physician assistants complete an internship at a palliative and/or hospice care provider (e.g. for one week).

85.3

46.9

 M26

n.c.

Before a GP is temporarily substituted with another, patients with high demand for care are discussed via a medical information handover during joint home-visits, with a corresponding exchange of documents.

90.6

64.5

Before a GP is temporarily substituted with another, patients with high demand for care are discussed via a medical information handover over the telephone, with a corresponding exchange of documents.

97.0

73.5