Table 3.

Synthesis of evidence and recommendations for the response of primary care to palliative care delivery during a pandemic.

Element of the response model	Findings of the review
Systems	Policies • Need for consistent and timely communications re. protocols and public health measures to primary healthcare services during pandemics18 • Recognised lack of attention to palliative care in modelling for epidemics20 • Low % of general practitioners feel confident in levels of government (national/local) working effectively together during pandemics18
Space	Provision of care at home • Previous pandemics have shown excess numbers of deaths in the community22 • Recognised need for more palliative care in the community19 including when patients are transitioned home for end-of-life care20 • Recognition that family carers may have to take on additional responsibilities and a clearly outlined need for psychosocial support19 • Need for emotional and financial support for family carers including debriefing21 and relief of responsibility19
Staff	General practice workforce • Shortage of general practitioners impacts on the ability to prepare for infectious disease pandemics18 • General practitioners were personally prepared to provide extra capacity18 Training and skills development • Palliative care was identified as a priority for training during pandemics for community health workers21 Staff resilience • Importance of ‘debriefing’ defined as a time to talk about the impact of caring for sick people on the emotional well-being of healthcare workers21 • Recognised importance of self-care, impact of multiple losses, moral distress over ethical issues and work within limited resources21
Stuff	The impact of other aspects of care delivery during pandemics were highlighted but not specifically in relation to palliative care. These included personal protective equipment, distancing, cleaning consulting areas, and adequate access to equipment and diagnostic tests including blood tests and x-rays.18