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Lutier T, Morel V, Robert G. Patients considérés dans leur dernière année de vie par leur médecin traitant : quelles attentes concernant leur avenir ? MÉDECINE PALLIATIVE 2023. [DOI: 10.1016/j.medpal.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
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Escourrou E, Joyeux T, Guilhem M, Oustric S, Gardette V. How general practitioners perceive the aging trajectory of oldest-old - A qualitative study. BMC PRIMARY CARE 2023; 24:5. [PMID: 36624382 PMCID: PMC9829226 DOI: 10.1186/s12875-023-01964-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 01/02/2023] [Indexed: 01/11/2023]
Abstract
BACKGROUND A new population of older people is growing: the oldest-old. The care of the oldest-old (individuals aged 90 and over) is a new challenge in primary care. This study aimed to analyze the perception of General Practitioners (GP) on (1) the aging process of their patients up to a very advanced age, (2) how to adapt their practice to the care of these patients. METHODS We conducted a qualitative study using focus group (face to face) and individual (video call) interviews of GPs in southwest France. The sampling was purposive. We analyzed the interviews using an inductive approach based on the phases of thematic analysis. We used researchers' triangulation during the process. Collection was concluded when saturation was reached. RESULTS Three focus groups and one individual interview were conducted with a total of seventeen general practitioners. GP perception concerning aging and very advanced age were based on their personal experience and their daily clinical practice. Aging was perceived as an individual, unconscious, unpredictable and irreversible phenomenon. The shift towards "very old age" appeared inevitable. It could be a physical or psychological shift, or patients neglecting themselves or lacking a project. The care of the oldest-old became more specific and individual, adapted to the wishes of the patient. Those adaptations involve medical disengagement to focus on the most essential outcomes. The objectives of health care needed to be less strict with limited invasive practices. Prevention needed to focus mainly on prevention of falls and limitation of functional decline. CONCLUSION GPs identified an inevitable and unpredictable shift from old age to very old age. The adaption of the theory of disengagement allowed us to identify a medical disengagement of the GPs in the care of their oldest patients.
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Affiliation(s)
- Emile Escourrou
- grid.15781.3a0000 0001 0723 035XDépartement Universitaire de Médecine Générale, Faculté de Médecine Rangueil, Université Paul Sabatier Toulouse III, 133 route de Narbonne, 31400 Toulouse, France ,grid.15781.3a0000 0001 0723 035XMaintain Aging Research team, CERPOP, Université de Toulouse, Université Paul Sabatier, Inserm, Toulouse, France ,Maison de Santé Pluriprofessionnelle Universitaire La Providence, Toulouse, France
| | - Thomas Joyeux
- grid.15781.3a0000 0001 0723 035XDépartement Universitaire de Médecine Générale, Faculté de Médecine Rangueil, Université Paul Sabatier Toulouse III, 133 route de Narbonne, 31400 Toulouse, France
| | - Matthieu Guilhem
- grid.15781.3a0000 0001 0723 035XDépartement Universitaire de Médecine Générale, Faculté de Médecine Rangueil, Université Paul Sabatier Toulouse III, 133 route de Narbonne, 31400 Toulouse, France
| | - Stéphane Oustric
- grid.15781.3a0000 0001 0723 035XDépartement Universitaire de Médecine Générale, Faculté de Médecine Rangueil, Université Paul Sabatier Toulouse III, 133 route de Narbonne, 31400 Toulouse, France ,grid.15781.3a0000 0001 0723 035XMaintain Aging Research team, CERPOP, Université de Toulouse, Université Paul Sabatier, Inserm, Toulouse, France ,Maison de Santé Pluriprofessionnelle Universitaire La Providence, Toulouse, France
| | - Virginie Gardette
- grid.15781.3a0000 0001 0723 035XMaintain Aging Research team, CERPOP, Université de Toulouse, Université Paul Sabatier, Inserm, Toulouse, France ,grid.411175.70000 0001 1457 2980Centre Hospitalier Universitaire de Toulouse, Toulouse, France
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Integrating general practitioners into crisis management would accelerate the transition from victim to effective professional: Qualitative analyses of a terrorist attack and catastrophic flooding. Eur J Gen Pract 2022; 28:125-133. [PMID: 35621696 PMCID: PMC9154808 DOI: 10.1080/13814788.2022.2072826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background In 2018, Trèbes, 6,000 inhabitants with nine general practitioners (GPs) in southern France, experienced two tragedies; a terrorist attack in March, in which four people were killed, and a catastrophic flood in October, in which six people died and thousands more were affected. Objectives We aimed to obtain a substantive theory for improving crisis management by understanding the personal and professional effects of the two successive disasters on GPs in the same village. Methods This qualitative study conducted complete interviews with eight GPs individually, with subsequent analyses involving the conceptualisation of categories based on grounded theory. Results The analysis revealed that GPs underwent a double status transition. First, doctors who experienced the same emotional shock as the population became victims; their usual professional relationship changed from empathy to sympathy. The helplessness they felt was amplified by the lack of demand from the state to participate in the first emergency measures; consequently, they lost their professional status. In a second phase, GPs regained their values and skills and acquired new ones, thus regaining their status as competent professionals. In this context, the participants proposed integrating a coordinated crisis management system and the systematic development of peer support. Conclusion We obtained valuable information on the stages of trauma experienced by GPs, allowing a better understanding of the effects on personal/professional status. Thus, the inclusion of GPs in adaptive crisis management plans would limit the effects of traumatic dissociation while increasing their professional effectiveness.
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Warner G, Baird LG, McCormack B, Urquhart R, Lawson B, Tschupruk C, Christian E, Weeks L, Kumanan K, Sampalli T. Engaging family caregivers and health system partners in exploring how multi-level contexts in primary care practices affect case management functions and outcomes of patients and family caregivers at end of life: a realist synthesis. BMC Palliat Care 2021; 20:114. [PMID: 34271897 PMCID: PMC8285870 DOI: 10.1186/s12904-021-00781-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 05/25/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND An upstream approach to palliative care in the last 12 months of life delivered by primary care practices is often referred to as Primary Palliative Care (PPC). Implementing case management functions can support delivery of PPC and help patients and their families navigate health, social and fiscal environments that become more complex at end-of-life. A realist synthesis was conducted to understand how multi-level contexts affect case management functions related to initiating end-of-life conversations, assessing patient and caregiver needs, and patient/family centred planning in primary care practices to improve outcomes. The synthesis also explored how these functions aligned with critical community resources identified by patients/families dealing with end-of-life. METHODS A realist synthesis is theory driven and iterative, involving the investigation of proposed program theories of how particular contexts catalyze mechanisms (program resources and individual reactions to resources) to generate improved outcomes. To assess whether program theories were supported and plausible, two librarian-assisted and several researcher-initiated purposive searches of the literature were conducted, then extracted data were analyzed and synthesized. To assess relevancy, health system partners and family advisors informed the review process. RESULTS Twenty-eight articles were identified as being relevant and evidence was consolidated into two final program theories: 1) Making end-of-life discussions comfortable, and 2) Creating plans that reflect needs and values. Theories were explored in depth to assess the effect of multi-level contexts on primary care practices implementing tools or frameworks, strategies for improving end-of-life communications, or facilitators that could improve advance care planning by primary care practitioners. CONCLUSIONS Primary care practitioners' use of tools to assess patients/families' needs facilitated discussions and planning for end-of-life issues without specifically discussing death. Also, receiving training on how to better communicate increased practitioner confidence for initiating end-of-life discussions. Practitioner attitudes toward death and prior education or training in end-of-life care affected their ability to initiate end-of-life conversations and plan with patients/families. Recognizing and seizing opportunities when patients are aware of the need to plan for their end-of-life care, such as in contexts when patients experience transitions can increase readiness for end-of-life discussions and planning. Ultimately conversations and planning can improve patients/families' outcomes.
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Affiliation(s)
- Grace Warner
- School of Occupational Therapy, Dalhousie University, P.O. Box 15000, Halifax, Nova Scotia, B3H 4R2, Canada.
| | - Lisa Garland Baird
- Faculty of Nursing, University of Prince Edward Island, 550 University Avenue, Charlottetown, PEI, C1A 4P3, Canada
| | - Brendan McCormack
- School of Health Sciences, Queen Margaret University, Queen Margaret University Drive, Musselburgh, EH21 6UU, Scotland
| | - Robin Urquhart
- Department of Community Health and Epidemiology, Dalhousie University, 5790 University Avenue, Halifax, NS, B3H 1V7, Canada
| | - Beverley Lawson
- Department of Family Medicine, Dalhousie University, 1465 Brenton Street, Suite 402, Halifax, Nova Scotia, B3J 3T4, Canada
| | - Cheryl Tschupruk
- Palliative Care Integration, Nova Scotia Health Authority, 530C Bethune Building, 1276 South Park st, Halifax, NS, Canada
| | - Erin Christian
- Primary Health Care Implementation, Nova Scotia Health Authority, 6960 Mumford Road, Suite 2068, Halifax, NS, B3L 4P1, Canada
| | - Lori Weeks
- School of Nursing, Dalhousie University, P.O. Box 15000, Halifax, Nova Scotia, B3H 4R2, Canada
| | - Kothai Kumanan
- Palliative Care Integration, Nova Scotia Health Authority, Room 522 Bethune Building, 1276 South Park St, Halifax, NS, B3H 2Y9, Canada
| | - Tara Sampalli
- Research, Innovation and Discovery, Nova Scotia Health Authority, Halifax, Canada
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Fasting A, Hetlevik I, Mjølstad BP. Palliative care in general practice; a questionnaire study on the GPs role and guideline implementation in Norway. BMC FAMILY PRACTICE 2021; 22:64. [PMID: 33827448 PMCID: PMC8028821 DOI: 10.1186/s12875-021-01426-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 03/29/2021] [Indexed: 11/30/2022]
Abstract
Background Patients in need of palliative care often want to reside at home. Providing palliative care requires resources and a high level of competence in primary care. The Norwegian guideline for palliative care points to the central role of the regular general practitioner (RGP), specifying a high expected level of competence. Guideline implementation is known to be challenging in primary care. This study investigates adherence to the guideline, the RGPs experience with, and view of their role in palliative care. Methods A questionnaire was distributed, by post, to all 246 RGPs in a Norwegian county. Themes of the questionnaire focused on experience with palliative and terminal care, the use of recommended work methods from the guideline, communication with partners, self-reported role in palliative care and confidence in providing palliative care. Data were analyzed descriptively, using SPSS. Results Each RGP had few patients needing palliative care, and limited experience with terminal care at home. Limited experience challenged RGPs possibilities to maintain knowledge about palliative care. Their clinical approach was not in agreement with the guideline, but most of them saw themselves as central, and were confident in the provision of palliative care. Rural RGPs saw themselves as more central in this work than their urban colleagues. Conclusions This study demonstrated low adherence of the RGPs, to the Norwegian guideline for palliative care. Guideline requirements may not correspond with the methods of general practice, making them difficult to adopt. The RGPs seemed to have too few clinical cases over time to maintain skills at a complex and specialized level. Yet, there seems to be a great potential for the RGP, with the inherent specialist skills of the general practitioner, to be a key worker in the palliative care trajectory. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01426-8.
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Affiliation(s)
- Anne Fasting
- General Practice Research Unit, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, PO Box 8905 MTFS, N-7491, Trondheim, Norway. .,Unit for Palliative Care and Chemotherapy Treatment, Cancer Department, More Og Romsdal Hospital Trust, Kristiansund Hospital, N-6508 Kristiansund N, Norway.
| | - Irene Hetlevik
- General Practice Research Unit, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, PO Box 8905 MTFS, N-7491, Trondheim, Norway
| | - Bente Prytz Mjølstad
- General Practice Research Unit, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, PO Box 8905 MTFS, N-7491, Trondheim, Norway.,Saksvik legekontor, Saxe Viks veg 4, N-7562, Hundhammeren, Norway
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Boudy CA, Bouchez T, Caprini D, Pourrat I, Munck S, Barbaroux A. Home-based palliative care management: what are the useful resources for general practitioners? a qualitative study among GPs in France. BMC FAMILY PRACTICE 2020; 21:222. [PMID: 33129251 PMCID: PMC7603704 DOI: 10.1186/s12875-020-01295-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 10/22/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Most French people (71%) would like to die at home, but only one out of four actually do. While the difficulties inherent in the practice of home-based palliative care are well described, few studies highlight the resources currently used by general practitioners (GPs) in real life. We have therefore sought to highlight the resources actually used by GPs providing home-based palliative care. METHODS Twenty-one GPs of different ages and practice patterns agreed to participate to this qualitative study based upon semi-structured interviews. They were recruited according to a purposive sampling. Transcripts analysis was based upon General Inductive Analysis. RESULTS The resources highlighted have been classified into two main categories according to whether they were internal or external to the GPs. The internal resources raised included the doctor's practical experience and continuous medical education, personal history, work time organization and a tacit moral contract related to the referring GP's position. External resources included resource personnel, regional assistance platforms and health facilities, legislation. CONCLUSION This study provides a simple list that is easy to share and pragmatic solutions for GPs and policymakers. Home-based palliative care practice can simultaneously be burdensome and yet a fulfilling, meaningful activity, depending on self-efficacy and professional exhaustion (burnout), perhaps to a greater extent than on medical knowledge. Home-based palliative care promotion is a matter of social responsibility. The availability of multidisciplinary teams such as regional assistance platforms and Hospitalization at Home is particularly important for the management of palliative care. Policymakers should consolidate these specific resources out of hospitals, in community settings where the patients wish to end their life.
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Engberink AO, Mailly M, Marco V, Bourrie D, Benezech JP, Chevallier J, Vanderhoeven S, Crosnier R, Bourrel G, Lognos B. A phenomenological study of nurses experience about their palliative approach and their use of mobile palliative care teams in medical and surgical care units in France. BMC Palliat Care 2020; 19:34. [PMID: 32197609 PMCID: PMC7085140 DOI: 10.1186/s12904-020-0536-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 03/02/2020] [Indexed: 11/28/2022] Open
Abstract
Background Despite a broad consensus and recommendations, numerous international reports or studies have shown the difficulties of implementing palliative care within healthcare services. The objective of this study was to understand the palliative approach of registered nurses in hospital medical and surgical care units and their use of mobile palliative care teams. Methods Qualitative study using individual in depth semi-structured interviews and focus group of registered nurses. Data were analyzed using a semiopragmatic phenomenological analysis. Expert nurses of mobile palliative care team carried out this study. 20 registered nurses from three different hospitals in France agreed to participate. Results Nurses recognize their role as being witnesses to the patient’s experience through their constant presence. This is in line with their professional values and gives them an “alert role” that can anticipate a patient-centered palliative approach. The physician’s positioning on palliative care plays a key role in its implementation. The lack of recognition of the individual role of the nurse leads to a questioning of her/his professional values, causing inappropriate behavior and distress. According to nurses, “rethinking care within a team environment” allows for the anticipation of a patient-centered palliative approach. Mobile Palliative Care Team highlights the major role of physicians-nurses “balance” while providing personal and professional support. Conclusions The Physician’s positioning and attitude toward palliative approach sets the tone for its early implementation and determines the behavior of different staff members within healthcare service. “Recognition at work”, specifically “recognition of the individual role of nurse” is an essential concept for understanding what causes the delay in the implementation of a palliative approach. Interprofessional training (physicians and nurses) could optimize sharing expertise. Registered nurses consider MPCT as a “facilitating intermediary” within the healthcare service improving communication. Restoring a balance in sharing care and decision between physicians and other caregivers lead care teams to an anticipated and patient-centered palliative approach according to guidelines.
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Affiliation(s)
- Agnès Oude Engberink
- University of montpellier CEPS platform, site Saint Charles, 34000, Montpellier, France. .,Maison de Santé Pluriprofessionnelle Universitaire Avicenne, 2 rue IBN Sinai dit Avicenne, 66330, Cabestany, France. .,Department of Palliative Care, CHU Montpellier, Montpellier, France.
| | - Maryse Mailly
- Mobile Palliative Care Team, CHU Montpellier, Montpellier, France
| | - Valerie Marco
- Department of General Medecine, University of Montpellier, avenue du Doyen Gaston Giraud, 34000, Montpellier, France
| | - Daniele Bourrie
- Department of General Medecine, University of Montpellier, avenue du Doyen Gaston Giraud, 34000, Montpellier, France
| | - Jean-Pierre Benezech
- Department of General Medecine, University of Montpellier, avenue du Doyen Gaston Giraud, 34000, Montpellier, France
| | | | - Sandrine Vanderhoeven
- Department of General Medecine, University of Montpellier, avenue du Doyen Gaston Giraud, 34000, Montpellier, France
| | - Remy Crosnier
- Mobile Palliative Care Team, CHU Montpellier, Montpellier, France
| | - Gérard Bourrel
- Maison de Santé Pluriprofessionnelle Universitaire Avicenne, 2 rue IBN Sinai dit Avicenne, 66330, Cabestany, France.,Department of Palliative Care, CHU Montpellier, Montpellier, France
| | - Béatrice Lognos
- University of montpellier CEPS platform, site Saint Charles, 34000, Montpellier, France.,Department of Palliative Care, CHU Montpellier, Montpellier, France
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General practitioners' perceptions of best practice care at the end of life: a qualitative study. BJGP Open 2019; 3:bjgpopen19X101660. [PMID: 31581119 PMCID: PMC6970580 DOI: 10.3399/bjgpopen19x101660] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 02/21/2019] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND GPs can play a central role in palliative care delivery. However, little is known about their views on what constitutes best practice care at the end of life. AIM To explore, in a sample of Australian GPs, their perceptions of best practice palliative care and their ideal role in its delivery. DESIGN & SETTING A qualitative interview study of 25 GPs practising in metropolitan and non-metropolitan locations in New South Wales, Australia. METHOD Semi-structured telephone interviews were conducted. Data were analysed using qualitative content analysis. RESULTS Participants had a mean age of 51 years, and had practised between 3 and 38 years (mean 19 years). Best practice palliative care was perceived to be proactive and responsive to a wide range of patient and family needs. Many participants indicated a need for relational continuity, which involves GPs establishing a care pathway from diagnosis to palliation, coordinating care across the pathway, and collaborating with other healthcare providers. A number of participants perceived palliative care as a natural extension of primary care and indicated that best practice palliative care mainly requires experiential knowledge and good communication skills, rather than specialised medical knowledge. Participants listed a number of communication strategies to offer patients and their families choice and ongoing negotiation about the recommended treatments. CONCLUSION This study provides novel in-depth insights into GPs' perceptions of best practice palliative care. Future research should further investigate the identified features of care, and whether they can maximise the outcomes of patients and their families.
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