51 The attitudes of general practitioners with regards to the inclusion of patients with dementia on general practice palliative care registers: a postal survey

<h3>Background</h3> Dementia is a degenerative disease causing memory loss and loss of daily functioning, with life expectancy 3 to 8 years. Patients with dementia have healthcare needs comparable to cancer patients yet have poor access to good end of life care, subjected to unplanned hospital admissions, burdensome investigations and inadequate pain control, often due to insufficient advance care planning and poor symptom identification. The Gold Standards Framework (GSF) helps GPs identify patients in their last year of life. 1% of the population dies each year, thus 1% of a practice list should be on the GSF register. GSF register patients receive better coordinated care including increased likelihood of dying in their preferred place. <h3>Aim</h3> To identify whether a patient’s dementia diagnosis prompts GPs to place them on their GSF register, and if so, when they are considered for inclusion; to explore GP attitudes about use of the register for patients with dementia, whether they think it is relevant or useful. <h3>Methods</h3> This study comprised a cross-sectional structured self-completion postal survey of GPs working across south-west England. Questionnaires sent to 619 GP practices. <h3>Results</h3> 141 completed questionnaires were returned (response rate 23%). The mean GP practice list was 9102 patients, with a mean of 31 patients on GSF registers, 0.3% of practice patients. 4 (13%) of these had dementia. Most GPs acknowledged dementia as a terminal illness and 72% think the GSF register is useful, yet only 36% place them on the register. Most felt the GSF was less relevant for those in care homes. GPs who used the GSF register for dementia patients felt more confident in providing their end of life care. <h3>Conclusions</h3> Patients with dementia are under-represented on practice palliative care registers. Barriers to inclusion of patients with dementia included uncertainty in prognostication, care home residence and the ‘last year of life’ criteria in GSF considered too long.