Wyatt, K;
Bastaki, H;
Davies, N;
(2021)
Delivering end-of-life care for patients with cancer at home: exploring the views and experiences of General Practitioners.
Health and Social Care in the Community
10.1111/hsc.13419.
(In press).
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Abstract
Many patients with terminal cancer wish to die at home and general practitioners in the United Kingdom have a critical role in providing this care. However, it has been suggested general practitioners lack confidence in end‐of‐life care. It is important to explore with general practitioners their experience and perspectives including feelings of confidence delivering end‐of‐life care to people with cancer. The aim of this study was to explore general practitioners experiences of providing end‐of‐life care for people with cancer in the home setting and their perceptions of confidence in this role as well as understanding implications this has on policy design. A qualitative study design was employed using semi‐structured interviews and analysed using thematic analysis. Nineteen general practitioners from London were purposively sampled from eight general practices and a primary care university department in 2018–2019, supplemented with snowballing methods. Five main themes were constructed: (a) the subjective nature of defining palliative and end‐of‐life care; (b) importance of communication and managing expectations; (c) complexity in prescribing; (d) challenging nature of delivering end‐of‐life care; (e) the unclear role of primary care in palliative care. General practitioners viewed end‐of‐life care as challenging; specific difficulties surrounded communication and prescribing. These challenges coupled with a poorly defined role created a spread in perceived confidence. Experience and exposure were seen as enabling confidence. Specialist palliative care service expansion had important implications on deskilling of essential competencies and reducing confidence levels in general practitioners. This feeds into a complex cycle of causation, leading to further delegation of care.
| Type: | Article |
|---|---|
| Title: | Delivering end-of-life care for patients with cancer at home: exploring the views and experiences of General Practitioners |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1111/hsc.13419 |
| Publisher version: | https://doi.org/10.1111/hsc.13419 |
| Language: | English |
| Additional information: | © 2021 The Authors. Health and Social Care in the Community published by John Wiley & Sons Ltd This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. |
| Keywords: | Cancer; end‐of‐life; end‐of‐life care; general practice; general practitioners; palliative care; qualitative research; |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health > Primary Care and Population Health |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10126419 |
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