Beernaert K, Deliens L, De Vleminck A, Devroey D, Pardon K, Van den Block J, Cohen J. Early identification of palliative care needs by family physicians: A qualitative study of barriers and facilitators from the perspective of family physicians, community nurses, and patients. Palliat Med. 2014 Feb 17;28(6):480-490.
Eerste auteur: Beernaert K.
Jaar: 2014
Type: Publicatie
Abstract:
Context: There is a growing recognition that a palliative care approach should be initiated early and not just in the terminal phase of patients with chronic life-limiting diseases. General practitioners (GPs) then play a central role in identifying and managing palliative care needs, but appear to not identify them accurately or in a timely manner.
Objective: To explore the barriers to and facilitators of the timely identification by GPs of the palliative care needs of their patients.
Methods: A qualitative study including focus groups with GPs (n=20) and community nurses (n=12) and interviews with patients (n=18) with cancer, organ failure and dementia. We performed a thematic analysis to derive themes that covered perceived barriers and facilitators.
Results: Key barriers and facilitators found in our study relate to communication styles, the perceived role of a GP, and continuity of care. GPs do not systematically assess non-acute care needs and patients do not mention them or even try to mask them from the GP. This is embedded within a predominant perception among patients, nurses and GPs of the GP as the person to appeal to in acute and standard follow-up situations rather than for palliative care needs. GPs also seemed to pay more often attention to palliative care needs of patients in a terminal phase.
Conclusion. The current practice of palliative care in Flanders is far from the presently considered ideal palliative care approaches. Facilitators such as pro-active communication and communication tools could contribute to the development of guidelines for GPs and policymakers in primary care.