Cambridge GP Dr Stephen Barclay has joined the University of Cambridge to carry out a three-year study of palliative care in the community for people with cancer. His research is funded by Macmillan Cancer Relief and he is based at the General Practice and Primary Care Research Unit.
Cambridge GP Dr Stephen Barclay has joined the University of Cambridge to carry out a three-year study of palliative care in the community for people with cancer. His research is funded by Macmillan Cancer Relief and he is based at the General Practice and Primary Care Research Unit.
"We know that within local hospices there is already an excellent standard of palliative care available for people with cancer and other life-threatening illnesses. What I want to do is raise the level of care available to people through primary care services. A large proportion of palliative care is delivered by primary care practitioners, without specialist input," explains Dr Barclay.
His research will address some of the difficult issues facing those who are responsible for the care of cancer patients. At what point should the doctor decide that currently available treatments would not help a patient? When should the doctor tell the patient they are beginning to lose the battle? When should palliative care begin? Dr Barclay is looking at these questions to improve the transition from hospital care to palliative care for terminally ill patients.
Dr Barclay is particularly interested in improving communication between primary and secondary care-givers to ensure that patients do not fall through the cracks in the system when they are shuffled between the two. When a specialist has decided to release a patient back to the GP or to a hospice, usually the only information given is a quick fax with scant information. Already Dr Barclay's research has found that a simple five-minute phone call can greatly improve patient care, helping the GP to make informed medical decisions as the patient approaches death. By avoiding unnecessary hospital visits or painful treatments, a GP can help to make the end of life more peaceful and less traumatic.
Although based at Cambridge, Dr Barclay's research extends beyond the city. He is using focus groups of GPs and district nurses in the seven primary care trusts in Cambridgeshire to determine what information they need from the specialists to give the best palliative care. He is examining the different needs of rural and city GPs and district nurses. Eventually, Dr Barclay hopes to hold a county-wide conference on this issue to give local GPs a unified voice with credibility and clout. Dr Barclay hopes that having established best practice locally he can produce recommendations which will be taken up nationally.
Dr Barclay sees education as a key means of improving palliative care. Medical students need training in the discipline, at the right time in their education.
"In Cambridgeshire, a doctor must deliver at least five babies to qualify as a GP, but quite often, a doctor never delivers another baby after that," Dr Barclay says. "Yet within one month of qualifying they will probably witness at least one death without having done so before."
Currently he is discussing ways to improve palliative care education with the Dean of the Clinical School, possibly by making it an exam subject in medical finals.
Image: Photo Disc
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