End-of-life care in rural general practice: how best to support commitment and meet challenges?

BMC Palliative Care

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[1] 0000 0004 1936 7857, grid.1002.3, School of Nursing and Midwifery, Monash University, Wellington Road, 3800, Clayton, Victoria, Australia;0000 0004 1936 7910, grid.1012.2, Medical School, The University of Western Australia, 35 Stirling Highway, 6009, Perth, WA, Australia;0000 0004 1936 7910, grid.1012.2, School of Population and Global Health, The University of Western Australia, 35 Stirling Highway, 6009, Perth, Western Australia, Australia;

关键词: End-of-life care;    Palliative care;    General practitioners;    Other stakeholders;    Qualitative study;   

DOI  :  10.1186/s12904-019-0435-4

来源: publisher

【 摘 要 】

BackgroundFew studies have specifically assessed the scope, nature and challenges of palliative and end-of-life care in rural general practice. These knowledge gaps limit the development of evidence-based policies and services for patients in the last months of life. This study aimed to explore the perspectives of general practitioners (GPs) and other stakeholders on rural GPs’ involvement and challenges in providing palliative and end-of-life care in regional Australia.MethodsA qualitative study involving five focus groups with 26 GPs based in rural/regional Western Australia together with 15 individual telephone interviews with four GPs and 11 other stakeholders involved in end-of-life care across Australia.ResultsThe rural GPs’ central role in end-of-life care was recognized by the majority of participants but multiple challenges were also identified. Some challenges were comparable to those found in urban settings but others were more pronounced, including resource limitations and lack of training. Inappropriate payment models discouraged GPs’ involvement in some aspects of end-of-life care, such as case conferences and home visits. Compared to GPs in urban settings, those in rural/regional communities often reported closer doctor-patient relationships and better care integration and collaboration. These positive aspects of care could be further developed to enhance service provision. Our study highlighted the importance of regular interactions with other professionals and patients in providing end-of-life care, but many GPs and other stakeholders found such interactions more challenging than the more “technical” aspects of care.ConclusionsRural/regional GPs appear to be disproportionately affected by inappropriate payment models and limited resources, but may benefit from closer doctor-patient relationships and better care integration and collaboration relative to urban GPs. Systematic collection of empirical data on GP management at end-of-life is required to build on these strengths and address the challenges.

【 授权许可】

CC BY