Finding their place – general practitioners' experiences with palliative care—a Norwegian qualitative study

Abstract

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.

Put on the sidelines of palliative care: a qualitative study of important barriers to GPs’ participation in palliative care and guideline implementation in Norway

“…Individual PCTs’ propensity to ‘take over’ and provide total care for their patients could not fully explain differences in culture, as GPs from different municipalities affiliated with the same PCT could give contradictory descriptions of how the PCT team acted. The different cultures seemed to follow a pattern consistent with previous findings showing that rural GPs are more involved in palliative care than their urban colleagues [ 26 , 27 , 39 ]. Although this could mean that rural residents benefit from the close involvement of GPs, the finding must also be seen in light of the fact that the demands for specialised palliative care services in Norway exceed the existing resources [ 3 ].…”

“…GPs’ experiences with palliative care, including reflections about their role, were explored. They were thereafter presented with extracts from the guideline, and the descriptions of their role and competence requirements were discussed [ 27 ].…”

“…A previously published paper from this study showed that the GPs generally had positive attitudes toward palliative care and highlighted their strengths in this work. However, GPs’ involvement varied, and some struggled to find their role [ 27 ].…”

How family physicians introduce palliative care to patients with chronic illnesses

“…22 It has been consistently reported that patients prefer to have palliative conversations in the primary care setting as their relationships with their FPs allow for more individualized and effective dialogue. 21,23,24…”

“…22 It has been consistently reported that patients prefer to have palliative conversations in the primary care setting as their relationships with their FPs allow for more individualized and effective dialogue. 21,23,24 The current literature also identified ongoing barriers to FPs engaging in palliative conversations. These included physician-dependent uptake (often related to comfort and experience), demands on time, lack of compensation/value for the work, and limited practical resources.…”