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Original research
General practitioners’ engagement in end-of-life care: a semi-structured interview study
  1. Laura Deckx1,
  2. Geoffrey Mitchell1,
  3. John Rosenberg2,
  4. Michaela Kelly1,
  5. Sue-Ann Carmont1 and
  6. Patsy Yates2
  1. 1 Primary Care Clinical Unit, School of Clinical Medicine, University of Queensland, Brisbane, Queensland, Australia
  2. 2 School of Nursing, Queensland University of Technology Faculty of Health, Kelvin Grove, Queensland, Australia
  1. Correspondence to Professor Geoffrey Mitchell, School of Clinical Medicine, University of Queensland, Brisbane, 4006, Queensland, Australia; g.mitchell{at}uq.edu.au

Abstract

Background Early identification of approaching end-of-life and care planning improve outcomes at the end of life. Nevertheless, the majority of people who die are not identified in time to enable appropriate care planning. We aimed to describe the challenges general practitioners (GPs) found in providing end-of-life care; what prompted GPs to identify and discuss approaching end of life with their patient and how their practice changed.

Methods We conducted a qualitative study of 15 Australian GPs using semi-structured interviews, examining end-of-life care of one of their randomly selected, deceased patients. Interviews were analysed using a general inductive approach.

Results When a life-limiting prognosis was articulated, GPs integrated end-of-life care into their clinical care directly. Care often included a care plan developed in consultation with the patient. Even when death was not articulated, GPs were aware of approaching end of life and changed their focus to comfort of the patient. GPs generally had an informal care plan in mind, but this developed gradually and without discussing these plans with the patient. How GPs provided end-of-life care depended primarily on patient traits (eg, willingness to discuss physical decline) and the GP’s characteristics (eg, experience, training and consulting style).

Conclusions GPs were aware of their patients’ approaching end of life and care was adjusted accordingly. However, under certain circumstances this was not explicitly articulated and discussed. It is not clear if implicit but unarticulated end-of-life care is sufficient to meet patients’ needs. Future studies should investigate this.

  • palliative care
  • terminal care
  • general practice
  • advance care planning
  • qualitative research

Data availability statement

Data are available on reasonable request.

https://doi.org/10.1136/bmjspcare-2019-001817

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    Data availability statement

    Data are available on reasonable request.

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    Footnotes

    • LD and GM contributed equally.

    • Contributors LD, GM, JR and PY contributed to the design of the study; MK, LD and S-AC contributed to the acquisition of data; LD and JR performed the analysis; all authors contributed to the interpretation of data. LD and GM drafted the article and all authors revised the paper critically for important intellectual content. All authors approved the version to be published, and have participated sufficiently in the work to take public responsibility for the content.

    • Funding This work was supported by the NHMRC Centre of Research Excellence in End of Life Care (1060254).

    • Competing interests None declared.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.