RCGP research fellowships for Palliative Care and Mental Health: where are they now?

Dr Huw Williams, Clinical Research Fellow, Cardiff University

Dr Ian Morgan, GP at Brampton Medical Practice 

Dr Huw Williams is a Clinical Research Fellow in the Primary Care PatIent SAfety (PISA) Study Group at Cardiff University, and is the winner of the Palliative Care Research Fellowship, awarded by RCGP in partnership with Marie Curie.

"Patients approaching the end of their lives often struggle to access the care they need out of hours. The RCGP/Marie Curie Palliative Care Research Fellowship called for proposals which tackled the dearth of research addressing 24/7 palliative care.  Dr Huw Williams has been using the PISA team’s expertise to analyse 1200 patient safety incident reports involving patients requiring palliative care in the Out-of-Hours (OOH) setting submitted to the National Reporting and Learning System (NRLS). 

Analysis of the 1200 reports is well underway, revealing 3 main areas of harm:

  • Acquisition of, prescribing for, and administration of medications via a syringe driver
  • Accessing care when required in a timely manner
  • Achieving preferred place of care and/or death

A scoping review of the literature to identify existing interventions and initiatives addressing these areas of concern is also being undertaken alongside a colleague at the University of South Wales.  This combination of incident report analysis and scoping review will inform a Quality improvement project in a local OOH service (Aneurin Bevan University Health Board). 

 

Much of the time thus far has been spent meeting with and generating enthusiasm amongst key stakeholders. The next stage is shadowing nurses and GPs to see how the service is currently delivered and organisation of a stakeholder event to identify local improvement priorities.

It has been extremely encouraging to see the excellent work being done in the Health Board already to try to improve care for patients at a time when they are at their most vulnerable.  The RCGP Marie Curie fellowship will galvanise and empower these efforts, allowing for a real assessment of what works to improve these services."

Dr Ian Morgan is a full-time GP in Cumbria with a particular interest in mental health, and is the winner of the Helen Lester Mental Health Research Fellowship, which RCGP funded through the Helen Lester appeal. The appeal was set up in memory of Helen Lester, former Chair of the RCGP Clinical Innovation and Research Centre, who worked tirelessly to provide support to patients with mental health problems. The award aimed to improve the lives of those living with mental health problems across the UK.

"Current guidelines appear to suggest that the first GP consultation for low mood is a vehicle for assessment, diagnosis, and for the formulation of a management plan; but not in itself therapeutic. However, patients often report to GPs that they find even initial discussion about their low mood beneficial: Most GPs will have experienced positive comments from a patient (e.g. “I feel better having talked to you”) at the end of such a consultation.  In contrast, in other first consultations with the same practitioner, no such benefit is suggested.  Indeed, other mental health professional report that patients sometimes find that their first consultation with a GP was a largely, or indeed entirely, negative experience.  We aim to investigate these differences in patient-perceived benefit.

We know that factors such as developing rapport, active listening and empathy – in other words a ‘patient-centred approach’ – increase patient satisfaction in all GP consultations.  Indeed, previous studies have confirmed the benefits of such an approach in the setting of mental health and depression.

However, the large variation in perceived benefit from case to case with an individual GP (above) suggests that there may be other factors within the consultation, specific for low mood, that patients find to be beneficial, that have not yet been explored.  Moreover, none of the previous studies have been structured such that the influence of specific management strategies, such as antidepressants or psychological therapies can be excluded from any benefit(s) perceived by the patient.

We have already run a pilot in which patients with low mood were sent a questionnaire 1-2 weeks after their first consultation with a GP. Early results confirm that many patients report feeling better after such consultations. Patients particularly valued normalisation of their condition and the offer of treatment.

The Helen Lester Fellowship is being used to run a larger study, using an extended questionnaire plus focus groups to obtain more detailed patient perspectives. We hope the results of our study will provide crucial information as to how such consultations can be tailored to improve patient satisfaction."

 

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