General practitioners (GPs) are important providers and coordinators of palliative home care (PHC). Through this double role, their perspectives and their treatment decisions influence PHC fundamentally. This study aims to gain deeper insights into GPs’ perspectives regarding PHC in North Rhine, Germany.
Methods:
An explorative, semistructured focus group was conducted with 7 doctors. The researchers performed content analysis. Main topics were GPs’ role definition in PHC and GPs’ medical activities in PHC.
Results:
Participating GPs describe their role in PHC, based on high motivation and positive attitudes toward PHC as a hybrid role: coordinator, provider (mostly in general PHC), and referrer (gateway to palliative care [PC] specialists). According to GPs’ medical activity, participants describe moderate expertise, demanding tasks, and elaborate PHC provision for GPs. Participants stressed the importance of PC in GPs’ work. But also PC is a small field in general practice. GPs’ PHC benefits from the deep trust resulting from the often close and long-term GP–patient relationship. Complexity and bureaucracy of PHC structures as well as the lack of resources and multidisciplinary cooperation are named as barriers for providing PHC. The highest level of care is reached in specialized PHC, which only very few, severely impaired patients need.
Conclusions:
Participating GPs see themselves as important PHC providers as well as referrers and coordinators. Complexity and discontinuity in PC arrangements create challenges for their provision. Therefore, they long for reduced bureaucratic burdens.
KratelU. Fortschritte in der ambulanten palliative care-versorgung in deutschland—eine bestandsaufnahme. DZO (Deutsche Zeitschrift für Onkologie). 2014;46(1):8–15.
4.
JohnsonCEMcVeyPRheeJJO, et al.General practice palliative care: patient and carer expectations, advance care plans and place of death—a systematic review. BMJ Support Palliat Care. 2018;1–10. doi:10.1136/bmjspcare-2018-001549.
AriasNGarraldaERheeJY, et al.EAPC Atlas of Palliative Care in Europe 2019. Vilvoorde, Belgium: EAPC Press. 2019. https://dadun.unav.edu/handle/10171/56787. Updated May 2019. Accessed April 11, 2020.
7.
SchnakenbergRGoeldlinAStielCBBleckwennMWeckbeckerKRadbruchL. Written survey on recently deceased patients in Germany and Switzerland: how do general practitioners see their role?BMC Health Serv Res. 2016;16(22):PMC4719660.
8.
MitchellSLoewJSandersCMDaleJ. Providing end-of-life care in general practice: findings of a national GP questionnaire survey. Br J Gen Pract. 2016;66(650):e647–e653.
9.
PypePSymonsLWensJvan den EyndenBStesADeveugeleM. Health care professionals’ perceptions towards lifelong learning in palliative care for general practitioners: a focus group study. BMC Fam Pract. 2014;15:36.
10.
ScholtenNGüntherALPfaffHKarbachU. The size of the population potentially in need of palliative care in Germany—an estimation based on death registration data. BMC Palliat Care. 2016;15(29). doi:10.1186/s12904-016-0099-2.
11.
LiuJTGoughIKFarabiNAnimikwamFWeersSBPhillipsJ. The role of primary care physicians in providing end-of-life care. Am J Hosp Palliat Care. 2018:1049909118808232. doi:10.1177/1049909118808232.
12.
SchwabeSAtesGEwertB, et al.Der spielt im Moment nicht mehr ganz die Rolle”: Der Hausarzt in der spezialisierten ambulanten Palliativversorgung aus Patientenperspektive. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2017;60(1):55–61.
13.
HagemeierA. Erfolge und Probleme der ambulanten Palliativversorgung nach Einführung der spezialisierten ambulanten Palliativversorgung (SAPV): Eine Untersuchung im Raum Neumünster. [Dissertation]. Hamburg, Germany: Universität Hamburg; 2014.
14.
Gesetz zur Verbesserung der Hospiz- und Palliativversorgung in Deutschland: Hospiz- und Palliativgesetz - HPG; 2015. Bundesanzeiger Verlag GmbH, Cologne, Bundesgesetzblatt (48):2114–2118.
15.
§ 39 SGB V Krankenhausbehandlung. In: Sozialgesetzbuch (SGB V), Fünftes Buch, Gesetzliche Krankenversicherung; Zuletzt geändert durch Art. 4 G v. 2017I3214.
16.
MaetensABeernaertKDeliensLAubryRRadbruchLCohenJ.Policy measures to support palliative care at home: a cross-country case comparison in three European countries. J Pain Symptom Manage. 2017;54(4):523–529.e5.
AlbrechtEBauseweinCRollerSVoltzR. Betreuungsorte und organisatorische Aspekte: Wann beginnt Palliativmedizin? In: BauseweinCRollerSVoltzR, eds. Leitfaden Palliative Care: Palliativmedizin und Hospizbetreuung. 5. Aufl. München, Germany: Elsevier Urban & Fischer; 2015:497–505. https://institut.elsevierelibrary.de/product/leitfaden-palliative-care-5. Accessed April 11, 2020.
19.
PrützFSaßAC. Daten zur palliativversorgung in deutschland: welche datenquellen gibt es, und was sagen sie aus?Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2017;60(1):26–36.
RiffinCPillemerKChenEKWarmingtonMAdelmanRDReidMC. Identifying key priorities for future palliative care research using an innovative analytic approach. Am J Public Health. 2015;105(1):e15–e21.
23.
FlickU. Qualitative Sozialforschung: Eine Einführung. Völlig überarbeitete und erweiterte Neuausgabe, 7. Auflage, Originalausgabe. Reinbek bei Hamburg: Rowohlt Taschenbuch; 2016. rororo Rowohlts Enzyklopädie.
24.
MorganDL. Focus Groups as Qualitative Research. Newbury Park: Sage. 1988.
25.
BehmannMLückmannSLSchneiderN. Palliative care in Germany from a public health perspective: qualitative expert interviews. BMC Res Notes. 2009;2(116). doi:10.1186/1756-0500-2-116.
26.
LuxEA. Chance für die ambulante Palliativversorgung. Schmerzmedizin. 2017;33(6):52–53.
27.
GardinerCGottMIngletonC. Factors supporting good partnership working between generalist and specialist palliative care services: a systematic review. Br J Gen Pract. 2012;62(598):e353–e362.
28.
GidwaniRNevedalAPatelM, et al.The appropriate provision of primary versus specialist palliative care to cancer patients: oncologists’ perspectives. J Palliat Med. 2017;20(4):395–403.
29.
MalikSGoldmanRKevorkN, et al.Engagement of primary care physicians in home palliative care. J Palliat Care. 2017;32(1):3–10.
30.
AfsharKGeigerKMüller-MundtGBleidornJSchneiderN. Hausärztliche palliativversorgung bei nichtonkologischen patienten: eine übersichtsarbeit. Schmerz. 2015;29(6):604–615.
GreenbaumTL. Moderating Focus Groups: A Practical Guide for Group Facilitation. Thousand Oaks, CA, London, United Kingdom, New Delhi, India: SAGE Publications; 2000.
34.
MorganDL. The Focus Group Guidebook. Thousand Oaks, CA, London, United Kingdom, New Delhi, India: SAGE Publications; 1998. Focus group kit; 1.
BengtssonM. How to plan and perform a qualitative study using content analysis. Nursing Plus Open. 2016;2:8–14. doi:10.1016/j.npls.2016.01.001.
37.
MorseJM. Critical analysis of strategies for determining rigor in qualitative inquiry. Qual Health Res. 2015;25(9):1212–1222.
38.
BeckaDRieseARychlikRPTHuengesBRuscheH. Stand der hausärztlichen palliativversorgung in deutschland. ein systematischer literaturreview. Dtsch Med Wochenschr. 2014;139(44):2254–2258.
39.
KlindtworthKSchneiderNBleidornJ. Wie erleben Patienten mit unheilbaren, fortgeschrittenen Erkrankungen ihre häusliche Versorgung?Z Allg Med. 2013;89(4):159–164.
Rotar PavličDAarendonkDWensJRodrigues SimõesJALynchMMurrayS. Palliative care in primary care: European forum for primary care position paper. Prim Health Care Res Dev. 2019;20:e133. doi:10.1017/S1463423619000641.
42.
CareyMLZuccaACFreundMABryantJHerrmannARobertsBJ. Systematic review of barriers and enablers to the delivery of palliative care by primary care practitioners. Palliat Med. 2019;33(9):1131–1145.
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