Provision of palliative and end-of-life care in New Zealand residential aged care facilities: general practitioners' perspectives

Abstract

This exploratory study examined general practitioners’ (GPs) perspectives on delivering end-of-life care in the New Zealand residential aged care context. A general inductive approach to the data collected from semi-structured interviews with 17 GPs from 15 different New Zealand general practices was taken. Findings examine: (1) GPs’ life experience; (2) the GP relationship with the facilities and provision of end-of-life care; (3) the GP interaction with families of dying residents; and (4) GP relationship with hospice. The nature of the GP relationship with the facility influenced GP involvement in end-of-life care in aged care facilities, with GPs not always able to direct a facility’s end-of-life care decisions for specific residents. GP participation in end-of-life care was constrained by GP time availability and the costs to the facilities for that time. GPs reported seldom using hospice services for residents, but did use the reputation (cachet) associated with hospice practices to provide an authoritative buffer for their end-of-life clinical decisions when talking with families and residents. GP training in end-of-life care, especially for those with dementia, was reported as ad hoc and done through informal mentoring between GPs.

Palliative care delivery in residential aged care: bereaved family member experiences of the Supportive Hospice Aged Residential Exchange (SHARE) intervention

“…There are many potential reasons for bereaved families' expressed dissatisfaction in communication with GPs. Firstly, time and cost restraints preclude communicating at length with families [46,47].…”

“…There are many potential reasons for bereaved families’ expressed dissatisfaction in communication with GPs. Firstly, time and cost restraints preclude communicating at length with families [ 46 , 47 ]. Many of the cases of poor communication and care from GPs from families in this study focused on how communication was handled, and the extent to which GPs showed respect for residents and families.…”

Palliative care delivery in residential aged care: Bereaved family member experiences of the Supportive Hospice Aged Residential Exchange (SHARE) intervention

“…For GPs, this often means spending only a few hours a week doing rounds in a RAC facility and making decisions for residents within this time (41). As a result, the time available for communicating at length with residents and their families is not available (42). However, many of the cases of poor communication and care from GPs from families in this study focused on the way in which communication was handled, and the extent to which GPs showed respect for residents and families.…”

“…Only the views and experiences of bereaved family members are included in these findings. The views of RNs, GPs, HCA's, and PCNSs have been presented elsewhere (4,42,48). Nevertheless, the experiences of these bereaved family members provide both a unique insight into the benefits and challenges to the implementation of SHARE (49).…”

Palliative care delivery in residential aged care: Bereaved family member experiences of the Supportive Hospice Aged Residential Exchange (SHARE) intervention

“…Only the views and experiences of bereaved family members are included in these ndings. The views of registered nurses, GPs, healthcare assistants, and hospice nurse specialists have been presented elsewhere (4,47,50). Nevertheless, the experiences of these bereaved family members provide both a unique insight into the bene ts and challenges to the implementation of SHARE (51).…”