The GP’s perceived role and use of language concerning the existential dimension of palliative patients

Abstract

Background: Palliative patients have to cope with their disease and impending death. Knowing what this means for a patient is crucial for person-centrered care. Although guidelines state it is a GP core task to explore existential issues of palliative patients, this is not standard practice.Aim: Exploring Dutch GPs’ perceived role regarding addressing the existential dimension of palliative patients, and which vocabulary is used.Design and Setting: Qualitative study among Dutch GPs. Participants were recruited by purposive sampling and snowballing, considering gender, working experience and world view.Method: Semi-structured in-depth interviews were performed, transcribed and analysed using content analysis.Results: Seventeen GPs participated. Three themes were identified: Language, Perceived role and Practice. Interviewees generally saw it as their role to pay attention to the existential dimension of their palliative patients. However, not all knew how to define this role, or how to refer patients with existential struggles to a spiritual counsellor. The multidisciplinary Dutch guideline ‘Existential and Spiritual Aspects of Palliative Care’ seemed largely unknown. Interviewees mostly fulfilled their role in an intuitive, pragmatic way. Questions such as “What does it mean for you to be seriously ill?” or “Do you have support from someone or something?” fitted daily practice.Conclusion: This study emphasizes the importance of basic GP education in exploring existential issues. The coexistence of a professionally obliged attention and an intuitive approach seems to be in conflict. We recommend enhancing collaboration between GPs and spiritual counsellors, appropriate training, and implementation of the relevant guideline on well-known platforms.