Gold Standards Framework to identify palliative care needs in primary care: a qualitative study of implementation in Brunei Darussalam

Background: The early identification of patients who may benefit from a palliative approach remains challenging in primary care. The Gold Standards Framework (GSF) provides a structured approach to identify patients who may be approaching the end of life; however, its implementation in primary care settings outside the United Kingdom remains poorly understood. To explore general practitioners' experiences of using the GSF prognostic indicator guidance to identify patients with palliative care needs in primary care in Brunei. Methods: This qualitative study was part of a broader mixed-methods project that evaluated the use of the GSF in primary care. Focus group discussions and small-group interviews were conducted with general practitioners who had applied the GSF in routine clinical practice following a structured training workshop. Data were audio-recorded, transcribed verbatim, and thematically analyzed using an inductive approach. Results: Ten general practitioners participated in this study. Four overarching themes were identified: (1) adapting the GSF to primary care practice, (2) structural constraints within primary care, (3) prognostic uncertainty and role discomfort, and (4) system enablers for integrating a palliative approach. While the GSF was perceived as a useful framework, its application required contextual adaptation and was influenced by both clinician- and system-level factors. Conclusion: The GSF can support the identification of patients with palliative care needs in primary care settings. However, effective implementation requires alignment with local workflows, improved continuity of care, and system-level support, including clear referral pathways and integrated care planning.