General practitioners’ practical approach to initiating end-of-life conversations: a qualitative study

Deckx, Laura; Thomas, Hayley; Sieben, Nicolas A.; Foster, Michele; Mitchell, Geoffrey

doi:10.1093/fampra/cmz074

Cited by 11 publications

(14 citation statements)

References 20 publications

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“…These findings indicate the importance of providing GPs and their patients in RACFs with the opportunity to discuss end-oflife issues. This may require policies and practices to support greater communication between GPs and both patients and staff at RACFs (Balmer et al, 2020;Deckx et al, 2019;Thomas et al, 2019).…”

Section: Ta B L E 1 Characteristics Of Participating Gpsmentioning

confidence: 99%

Comparison of end‐of‐life care for people living in home settings versus residential aged care facilities: A nationwide study among Australian general practitioners

Ding

Johnson

Auret

et al. 2021

Health Soc Care Community

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We have little knowledge of differences in end-of-life care between home settings and residential aged care facilities (RACFs) where people spend most of their last year of life. This study aimed to compare end-of-life care between home settings and RACFs from the perspective of Australian general practitioners (GPs). A descriptive study was conducted with 62 GPs from Western Australia, Queensland and Victoria.Participants were asked to provide reports on end-of-life care of decedents in their practice using a validated clinic-based data collection process developed by our team between September 2018 and August 2019. Of the 213 reported expected deaths, 66.2% mainly lived at home in the last year of life. People living at home were more likely to die at a younger age (median 77 vs. 88, p < 0.001), to be male (51.1% vs.33.3%, p = 0.01) and to die of cancer (53.9% vs. 4.2%, p < 0.001) compared to those in RACFs. There were no significant differences between the two patient groups for seven out of the eight assessed symptoms, except nausea. GPs' perceived roles in caring for patients and levels of their involvement in provision of common palliative care services were comparable between the two groups. The usual accommodation setting was most frequently considered the preferred place of death in both groups.However, more home residents ended up dying in hospital compared to RACF residents. There were significantly higher frequencies of end-of-life discussions (ORs ranged 5.46-9.82 for all topic comparisons) with GPs associated with people living at home versus RACFs. One opportunity for improved care is through promoting greater involvement of GPs in end-of-life discussions with RACF residents and staff.In general, more Australians could potentially remain at home until death if provided with greater access to essential specialist palliative care services and supportive services in home settings.

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Section: Ta B L E 1 Characteristics Of Participating Gpsmentioning

confidence: 99%

Comparison of end‐of‐life care for people living in home settings versus residential aged care facilities: A nationwide study among Australian general practitioners

Ding

Johnson

Auret

et al. 2021

Health Soc Care Community

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“…The qualitative analysis of the focus groups showed that PCPs felt empowered to take an active role in the follow-up of their patients during oncologic treatment. As described in the literature, PCPs felt responsible to initiate end-of-life discussions, arising from their role and expertise, and these conversations' bene ts (23,24). PCPs felt better equipped in communication skills, and picked up cues more easily to address advance directives or end-of-life discussions, having practiced in role plays and made their own experience with patients.…”

Section: ) Discussionmentioning

confidence: 99%

Shifting Palliative Care Paradigm in Primary Care From Better Death to Better End-of-Life : A Swiss Pilot Study

Sommer

Chung

Haller

et al. 2021

Preprint

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Background: Patients suffering from advanced cancer often loose contact with their primary care physician (PCP) during oncologic treatment and palliative care is introduced very late.The aim of this pilot study was to test the feasibility and procedures for a randomized trial of an intervention to teach PCPs a palliative care approach and communication skills to improve advanced cancer patients’ quality of life. Methods: Observational pilot study in 5 steps. 1) Recruitment of PCPs. 2) Intervention: training on palliative care competencies and communication skills addressing end-of-life issues.3) Recruitment of advanced cancer patients by PCPs. 4) Patients follow-up by PCPs, and assessment of their quality of life by a research assistant 5) Feedback from PCPs using a semi-structured focus group and three individual interviews with qualitative deductive theme analysis.Results: 8 PCPs were trained. PCPs failed to recruit patients for fear of imposing additional loads on their patients. PCPs changed their approach of advanced cancer patients. They became more conscious of their role and responsibility during oncologic treatments and felt empowered to take a more active role picking up patient’s cues and addressing advance directives. They developed interprofessional collaborations for advance care planning. Overall, they discovered the role to help patients to make decisions for a better end-of-life.Conclusions: PCPs failed to recruit advanced cancer patients, but reported a change in paradigm about palliative care. They moved from a focus on helping patients to die better, to a new role helping patients to define the conditions for a better end-of-life.Trial registration : The ethics committee of the canton of Geneva approved the study (2018-00077 Pilot Study) in accordance with the Declaration of Helsinki

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“…The qualitative analysis of the focus groups showed that PCPs felt empowered to take an active role in the follow-up of their patients during oncologic treatment. As described in the literature, PCPs felt responsible to initiate end-of-life discussions, arising from their role and expertise, and these conversations’ benefits [ 25 , 26 ]. PCPs felt better equipped in communication skills, and picked up cues more easily to address advance directives or end-of-life discussions, having practiced in role plays and made their own experience with patients.…”

Section: Discussionmentioning

confidence: 99%

Shifting palliative care paradigm in primary care from better death to better end-of-life: a Swiss pilot study

Sommer

Chung

Haller

et al. 2021

BMC Health Serv Res

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Background Patients suffering from advanced cancer often loose contact with their primary care physician (PCP) during oncologic treatment and palliative care is introduced very late. The aim of this pilot study was to test the feasibility and procedures for a randomized trial of an intervention to teach PCPs a palliative care approach and communication skills to improve advanced cancer patients’ quality of life. Methods Observational pilot study in 5 steps. 1) Recruitment of PCPs. 2) Intervention: training on palliative care competencies and communication skills addressing end-of-life issues. 3) Recruitment of advanced cancer patients by PCPs. 4) Patients follow-up by PCPs, and assessment of their quality of life by a research assistant 5) Feedback from PCPs using a semi-structured focus group and three individual interviews with qualitative deductive theme analysis. Results Eight PCPs were trained. Patient recruitment was a challenge for PCPs who feared to impose additional loads on their patients. PCPs became more conscious of their role and responsibility during oncologic treatments and felt empowered to take a more active role picking up patient’s cues and addressing advance directives. They developed interprofessional collaborations for advance care planning. Overall, they discovered the role to help patients to make decisions for a better end-of-life. Conclusions While the intervention was acceptable to PCPs, recruitment was a challenge and a follow up trial was not deemed feasible using the current design but PCPs reported a change in paradigm about palliative care. They moved from a focus on helping patients to die better, to a new role helping patients to define the conditions for a better end-of-life. Trial registration The ethics committee of the canton of Geneva approved the study (2018–00077 Pilot Study) in accordance with the Declaration of Helsinki.

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General practitioners’ practical approach to initiating end-of-life conversations: a qualitative study

Cited by 11 publications

References 20 publications

Comparison of end‐of‐life care for people living in home settings versus residential aged care facilities: A nationwide study among Australian general practitioners

Comparison of end‐of‐life care for people living in home settings versus residential aged care facilities: A nationwide study among Australian general practitioners

Shifting Palliative Care Paradigm in Primary Care From Better Death to Better End-of-Life : A Swiss Pilot Study

Shifting palliative care paradigm in primary care from better death to better end-of-life: a Swiss pilot study

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