BMJ Support Palliat Care doi:10.1136/bmjspcare-2011-000015
  • Research

What challenges good palliative care provision out-of-hours? A qualitative interview study of out-of-hours general practitioners

  1. Annmarie Nelson4
  1. 1Marie Curie Hospice Penarth, Penarth, South Glamorgan, UK
  2. 2Palliative Care Department, Velindre Hospital NHS Trust, Cardiff University, Cardiff, UK
  3. 3Department of Palliative Medicine, Royal Gwent Hospital, Newport, UK
  4. 4Wales Cancer Trials Unit, Marie Curie Cancer Care, Neuadd Meirionnydd, University Hospital of Wales, Cardiff, UK
  1. Correspondence to Dr Mark Taubert, Marie Curie Hospice Penarth, Bridgeman Road, Penarth CF64 3YR, UK; mtaubert{at}
  1. Contributors MT and AN conceived the study design. Interviews were conducted by MT. MT and AN carried out the data analysis. MT wrote the initial draft of the article and AN then made amendments and suggestions. Both then worked on shortening the original manuscript. SIRN was asked to read the article, edit and clarify several sections and remove quotations that were repetitive. All authors approved the final version of the manuscript. MT is guarantor for the article.


Background Not much is known about how general practitioners (GPs) who work regular out-of-hours shifts in the community feel about prescribing medication for symptom control in end-of-life care patients, how they gain palliative care experience and what they perceive as benefits and hindrances within service delivery to this vulnerable patient and carer group.

Objectives To determine, by interviewing GPs who provide out-of-hours care, aspects of care provision that augmented or challenged palliative care delivery.

Methods Semistructured interviews were conducted with GPs who worked out-of-hours shifts regularly. All interviews were analysed using interpretative phenomenological analysis.

Results Out-of-hours doctors were not confident about their palliative care knowledge and expressed a wish for more education. Lack of familiarity with patients requiring acute palliative care, compared with the closer bonds formed within the in-hours general practice setting, was perceived as troublesome and problematic, and lack of follow-up was felt to be a major factor. There was a clearly expressed fear of killing or harming patients with the strong drugs used in palliative care. Opiophobia, especially when faced with patients who were seen only once, affected prescribing decisions.

Conclusions This study provides further evidence of the needs of a specific subgroup of GPs. In-depth interview analysis of their experiences with palliative care provides a framework for which aspects are perceived as a hindrance in providing good palliative care, and can inform out-of-hours policy and teaching.


  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Accepted 30 March 2011.
  • Published Online First 21 April 2011

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