Out-of-hours palliative care:what are the educational needs and preferences of general practitioners?

Background: General practitioners (GPs) provide most out-of-hours medical care, but overall see few palliative patients. Keeping their knowledge and skills up-to-date is challenging. UK national policy has highlighted the importance of improving training for out-of-hours clinicians in order to reduce unnecessary admissions and support patients to die at home. However, little is known about the educational preferences of GPs working in this setting.Aims: To explore the confidence of out-of-hours GPs in symptom control, and to identify their educational needs and preferences in order to inform recommendations for future educational programmes.Methods: A structured postal survey was designed and sent to 1005 GPs employed by an independent provider of out-of-hours services across England. Quantitative data was analysed using descriptive statistics and non-parametric tests.Results: 203 (20.3%) GPs responded to the survey questionnaire. 13.3% (n=27) worked exclusively out-of-hours; they were typically older and more experienced. Confidence in assessing palliative care emergencies (42.8%, n=87: ‘not so confident’ or ‘not at all confident’), managing symptoms in non-cancer patients (39.4%, n=80) and prescribing a new syringe driver (39.0%, n=79) was lowest. Low confidence was associated with infrequent exposure (p<0.05) and lack of training (p<0.05). 12.8% (n=26) had never received formal palliative care training. Educational preferences were closely associated with confidence (p<0.0005); the above topics were most requested. E-learning was the preferred method (67.5%, n=137). GPs were more likely to prefer education with other GPs than with other professionals (p=0.001). 82.1% (n=165) felt training focused on out-of-hours work would be beneficial.Conclusions: Confidence in key palliative care competences is lacking. Educational strategies must be targeted at GPs needs, both in terms of content and delivery, with regular updates. E-learning is favoured, but should be combined with other approaches such as out-of-hours themed workshops. Specialist palliative care services should engage with out-of-hours providers to support education