Background Patients in need of palliative care often want to reside at home. Providing palliative care requires resources and a high level of competence in primary care. The Norwegian guideline for palliative care points to the central role of the regular general practitioner (RGP), specifying a high expected level of competence. Guideline implementation is known to be challenging in primary care. This study investigates adherence to the guideline, the RGPs experience with, and view of their role in palliative care. Methods A questionnaire was distributed, by post, to all 246 RGPs in a Norwegian county. Themes of the questionnaire focused on experience with palliative and terminal care, the use of recommended work methods from the guideline, communication with partners, self-reported role in palliative care and confidence in providing palliative care. Data were analyzed descriptively, using SPSS. Results Each RGP had few patients needing palliative care, and limited experience with terminal care at home. Limited experience challenged RGPs possibilities to maintain knowledge about palliative care. Their clinical approach was not in agreement with the guideline, but most of them saw themselves as central, and were confident in the provision of palliative care. Rural RGPs saw themselves as more central in this work than their urban colleagues. Conclusions This study demonstrated low adherence of the RGPs, to the Norwegian guideline for palliative care. Guideline requirements may not correspond with the methods of general practice, making them difficult to adopt. The RGPs seemed to have too few clinical cases over time to maintain skills at a complex and specialized level. Yet, there seems to be a great potential for the RGP, with the inherent specialist skills of the general practitioner, to be a key worker in the palliative care trajectory.
Background Modern palliative care focuses on enabling patients to spend their remaining time at home, and dying comfortably at home, for those patients who want it. Compared to many European countries, few die at home in Norway. General practitioners’ (GPs’) involvement in palliative care may increase patients’ time at home and achievements of home death. Norwegian GPs are perceived as missing in this work. The aim of this study is to explore GPs’ experiences in palliative care regarding their involvement in this work, how they define their role, and what they think they realistically can contribute towards palliative patients. Methods We performed focus group interviews with GPs, following a semi-structured interview guide. We included four focus groups with a total of 25 GPs. Interviews were recorded and transcribed verbatim. We performed qualitative analysis on these interviews, inspired by interpretative phenomenological analysis. Results Strengths of the GP in the provision of palliative care consisted of characteristics of general practice and skills they relied on, such as general medical knowledge, being coordinator of care, and having a personal and longitudinal knowledge of the patient and a family perspective. They generally had positive attitudes but differing views about their formal role, which was described along three positions towards palliative care: the highly involved, the weakly involved, and the uninvolved GP. Conclusion GPs have evident strengths that could be important in the provision of palliative care. They rely on general medical knowledge and need specialist support. They had no consensus about their role in palliative care. Multiple factors interact in complex ways to determine how the GPs perceive their role and how involved they are in palliative care. GPs may possess skills and knowledge complementary to the specialized skills of palliative care team physicians. Specialized teams with extensive outreach activities should be aware of the potential they have for both enabling and deskilling GPs.
Palliativ behandling av pasienter med covid-19 | Tidsskrift for Den norske legeforening Palliativ behandling av pasienter med covid-19 DEBATT ANNE-TOVE BRENNE E-post: anne.tove.brenne@ntnu.no Anne-Tove Brenne er ph.d., spesialist i onkologi, overlege ved Kreftklinikken, St. Olavs hospital, og postdok ved Institutt for klinisk og molekylaer medisin, NTNU. Forfatteren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. ARVE NORDBØArve Nordbø er spesialist i anestesiologi og overlege ved Palliativt senter, Sykehuset i Vestfold. Forfatteren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. SIRI STEINESiri Steine er spesialist i allmennmedisin og seksjonsoverlege ved Palliativt senter, Akershus universitetssykehus. Forfatteren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. ANNE FASTINGAnne Fasting er spesialist i allmennmedisin og overlege ved Palliativt team, Helse Møre og Romsdal, Molde og Kristiansund, og stipendiat ved Institutt for samfunnsmedisin og sykepleie, NTNU. Forfatteren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. MAREN ANNE BERGLUNDMaren Anne Berglund er spesialist i allmennmedisin og overlege ved Palliativt team, Sykehuset Innlandet, Hamar og Elverum. Forfatteren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. ENDRE RØYNSTRANDEndre Røynstrand er spesialist i indremedisin og i lungesykdommer og overlege ved Lindrende seksjon og Lungeseksjonen, Sørlandet sykehus, Arendal. Forfatteren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. NINA E. HJORTH Nina E. Hjorth er spesialist i indremedisin og i lungesykdommer, overlege ved Palliativt team, Haukeland universitetssjukehus, og ph.d.-kandidat ved Klinisk institutt 1, Universitetet i Bergen. Forfatteren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter.God palliasjon for pasienter kan sikres gjennom kunnskap, planlegging, beredskap og samarbeid på tvers av nivåer i helsetjenesten. Dette er spesielt viktig under en pandemi.Palliativ behandling har som mål å gi pasienter med livstruende sykdom god lindring og LITTERATUR:
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