67 The gold standards framework for improving the quality of end-of-life care in the community: a systematic review and qualitative synthesis

Background The Gold Standards Framework (GSF) was established in 2000 to help ensure delivery of high-quality end-of-life care within general practices, and has since been adapted for care homes and hospitals. The GSF has been endorsed by the UK Department of Health, with a national roll-out seeing all UK general practices and 25% of care homes adopting the GSF in some form. The evidence base for the GSF in the community has not been systematically evaluated. The aim of this study was to synthesise the qualitative evidence for the GSF on improving end-of-life care in the community. Method A systematic literature review of published research from 2000 to 2018 using Medline and PubMed databases, in line with PRISMA guidelines. A thematic matrix analyses approach was adopted. Studies were quality assessed using the QualSyt tool. Results Of the 115 studies identified, 19 studies reported on qualitative findings of the GSF implementation in the community setting. All 19 studies collected data from staff members and 4 studies also included patients and/or relatives. The GSF was felt to facilitate improved written and verbal communication in both nursing care homes and primary care teams, and to enhance methods of teamworking. 16 of 19 studies reported increased uptake of a palliative care register to identify end-of-life patients. Barriers to use of the GSF included a lack of sustainability due to high staff turnover, as well as an increased workload and difficulties in discussing end-of-life care with relatives. Conclusions These findings support the use of the GSF in improving the quality of end-of-life care through collaborative working and increased communication across healthcare teams. Further studies are required to understand attitudes of patients and relatives. Challenges for policy makers include ensuring end-of-life care tools are both sustainable and flexible according to local population and workforce needs.