GenPal Video, version 1, for HCPs
Early identification of palliative care needs in general practice, version 1 for GPs, Practice Nurses and Primary Health Networks. NPCC is the National Palliative Care Coordination project and is funded by the Australian Government Department of Health, Disability and Ageing.
Head to PCOC's YouTube channel to watch the GenPal video for HCPsIntroducing GenPal. A screening and decision support tool for general practice. It helps GPs identify patients with potential palliative care needs early using indicators and patient-reported outcome measures.
Cyclic GenPal screening begins in the General Practice Chronic Condition Clinic. GenPal is easy to implement—once set up, it runs mostly in the background, creating ongoing efficiencies for the practice.
Step 1: Identify Patients
Each month, general practice administration runs a preset search to identify patients who are aged 45 or more, diagnosed with at least one of the top five causes of expected death in Australia, and frequency of practice visits is on average once every 3 weeks. For those who meet this criteria, the GP then applies the surprise question.
Step 2: GP Review
Each GP reviews their patients on the list and applies the Surprise Question: “Would I be surprised if this patient died in the next 12 months?” Patients for whom the answer is yes, those names are removed from the list. Those patients remaining on the list are then invited to participate in regular screening with GenPal.
Step 3: Start screening
At the first appointment, the benefits of participating in the screening process is explained to the patient, consent is obtained, and patients are shown how to complete the screening on their phone using the Edmonton Symptom Assessment System. Patients submit screening results, in the waiting room, just prior to seeing the nurse or GP for a review.
The patient will be asked to respond to two questions and rate 11 symptoms on a scale from 0-10 based on the symptoms severity. Questions can be skipped if not relevant.
Patients also submit screening results at home, in between reviews at the practice. This means that the patient screening occurs every 3 weeks.
Step 4: Respond to results
Patients receive tailored symptom resources. These resources are based on their needs. High scores trigger follow-up resources and a repeat screening in 24 hours. The practice receives a notification email, with the subject line summarising the screening results, with concerning results highlighted.
The general practice responds according to their clinical pathway. Results are saved directly into the patient’s record.
Step 5: Consider Referral
If symptoms are problematic, the patient has reduced functioning, and a recent unplanned hospitalisation, the GP may consider referral to specialist palliative care using their clinical judgement.