Stakeholders’ views on identifying patients in primary care at risk of dying: a qualitative descriptive study using focus groups and interviews

Robin Urquhart, Jyoti Kotecha, Cynthia Kendell, Mary Martin, Han Han, Beverley Lawson, Cheryl Tschupruk, Emily Gard Marshall, Carol Bennett, Fred Burge

Strategies have been developed for use in primary care to identify patients at risk of declining health and dying, yet little is known about the perceptions of doing so or the broader implications and impacts. To explore the acceptability and implications of using a primary care-based electronic medical record algorithm to help providers identify patients in their practice at risk of declining health and dying. Qualitative descriptive study in Ontario and Nova Scotia, Canada. Six focus groups were conducted, supplemented by one-on-one interviews, with 29 healthcare providers, managers, and policymakers in primary care, palliative care, and geriatric care. Participants were purposively sampled to achieve maximal variation. Data were analysed using a constant comparative approach. Six themes were prevalent across the dataset: early identification is aligned with the values, aims, and positioning of primary care; providers have concerns about what to do after identification; how we communicate about the end of life requires change; early identification and subsequent conversations require an integrated team approach; for patients, early identification will have implications beyond medical care; and a public health approach is needed to optimise early identification and its impact. Stakeholders were much more concerned with how primary care providers would navigate the post-identification period than with early identification itself. Implications of early identification include the need for a team- based approach to identification and to engage broader communities to ensure people live and die well post-identification.