How do GPs identify a need for palliative care in their patients? An interview study

BMC Family Practice

Research Article

Yvonne Engels¹  Susanne JJ Claessen²  Luc Deliens³  Anneke L Francke⁴ 

[1] Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands;EMGO Institute for Health and Care Research, Department of Public and Occupational Health & Expertise Center Palliative Care VUmc, VU University medical center (VUmc), Amsterdam, The Netherlands;EMGO Institute for Health and Care Research, Department of Public and Occupational Health & Expertise Center Palliative Care VUmc, VU University medical center (VUmc), Amsterdam, The Netherlands;End-of-life Care Research Group, Ghent University & Vrije Universiteit Brussel, Brussels, Belgium;EMGO Institute for Health and Care Research, Department of Public and Occupational Health & Expertise Center Palliative Care VUmc, VU University medical center (VUmc), Amsterdam, The Netherlands;NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands;

关键词: General practice;    Primary care;    Palliative care;    Qualitative research;    End-of-life care;   

DOI  :  10.1186/1471-2296-14-42

 received in 2012-10-01, accepted in 2013-03-18,  发布年份 2013

来源: Springer

【 摘 要 】

BackgroundLittle is known about how GPs determine whether and when patients need palliative care. Little research has been done regarding the assumption underpinning Lynn and Adamson’s model that palliative care may start early in the course of the disease. This study was conducted to explore how GPs identify a need for palliative care in patients.MethodsA qualitative interview study was performed among 20 GPs in the Netherlands.ResultsGPs reported that a combination of several signals, often subtle and not explicit, made them identify a need for palliative care: signals from patients (increasing care dependency and not recuperating after intercurrent diseases) and signals from relatives or reports from medical specialists. GPs reported differences in how they identified a need for palliative care in cancer patients versus those with other diseases. In cancer patients, the need for palliative care was often relatively clear because of a relatively strict demarcation between the curative and palliative phase. However, in patients with e.g. COPD or in the very old, GPs' awareness of palliative care needs often arises gradually, relatively late in the disease trajectory.GPs consider the diagnosis of a life-threatening illness as a key point in the disease trajectory. However, this does not automatically mean that a patient needs palliative care at that point.ConclusionsGPs recognize a need for palliative care on the basis of various signals. They do not support the idea underlying Lynn and Adamson’s model that palliative care always starts early in the course of the disease.

【 授权许可】

CC BY   
© Claessen et al.; licensee BioMed Central Ltd. 2013