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Hooley RL, Payne S, Begovic D, Correa-Morales JE, Harding A, Hasselaar J, Preston N. Collaboration, coordination and communication as facilitators of transitions for patients with advanced cancer: a scoping review linked to the Pal-Cycles project. BMC Palliat Care 2024; 23:204. [PMID: 39112983 PMCID: PMC11304839 DOI: 10.1186/s12904-024-01510-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 07/10/2024] [Indexed: 08/11/2024] Open
Abstract
BACKGROUND Person-centred care is becoming increasingly recognised as an important element of palliative care. The current review syntheses evidence in relation to transitions in advanced cancer patients with palliative care needs. The review focuses on specific elements which will inform the Pal-Cycles programme, for patients with advanced cancer transitioning from hospital care to community care. Elements of transitional models for cancer patients may include, identification of palliative care needs, compassionate communication with the patient and family members, collaborative effort to establish a multi-dimensional treatment plan, review and evaluation of the treatment plan and identification of the end of life phase. METHODS A scoping review of four databases (MEDLINE, EMBASE, CINAHL, PsycINFO) was conducted to identify peer-reviewed studies published from January 2013 to October, 2022. A further hand-search of references to locate additional relevant studies was also undertaken. Inclusion criteria involved cancer patients transitions of care with a minimum of two of components from those listed above. Studies were excluded if they were literature reviews, if transition of care was related to cancer survivors, involved non-cancer patients, had paediatric population, if the transition implied a change of therapy and or a lack of physical transit to a non-hospital place of care. This review was guided by Arksey and O'Malley's framework and narrative synthesis was used. RESULTS Out of 5695 records found, 14 records were selected. Transition models identified: increases in palliative care consultations, hospice referrals, reduction in readmission rates and the ability to provide end of life care at home. Transition models highlight emotional and spiritual support for patients and families. No uniform model of transition was apparent, this depends on the healthcare system where it is implemented. CONCLUSIONS The findings highlight the importance of collaboration, coordination and communication as central mechanisms for transitional model for patients with advanced cancer. This may require careful planning and will need to be tailored to the contexts of each healthcare system.
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Affiliation(s)
- Rachel Louise Hooley
- International Observatory on End of Life Care, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK.
| | - Sheila Payne
- International Observatory on End of Life Care, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Dunja Begovic
- International Observatory on End of Life Care, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | | | - Andrew Harding
- International Observatory on End of Life Care, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Jeroen Hasselaar
- Department of Primary Care, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Nancy Preston
- International Observatory on End of Life Care, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
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Kjær LA, Tøien M, Førsund LH. Exploring nurse practitioners' collaboration with general practitioners in Norwegian homecare services: a qualitative study. Scand J Prim Health Care 2024:1-10. [PMID: 39034711 DOI: 10.1080/02813432.2024.2381064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 07/04/2024] [Indexed: 07/23/2024] Open
Abstract
OBJECTIVE Nurse practitioners (NPs) have recently been introduced in Norwegian homecare services. The NP role is still in an early implementation phase without standardized role descriptions. NPs are dependent on collaborating with general practitioners (GPs) in the care and treatment of patients. However, little is known about how NPs in Norway experience this collaboration. This study aims to explore how NPs working in homecare services describe their collaborative experiences with GPs, and what influence this collaboration. DESIGN The study had a qualitative descriptive design, applying individual, semi structured interviews to generate data from five Norwegian nurse practitioners working in homecare services. Data were analyzed using systematic text condensation. FINDINGS The NPs had varied experiences regarding the collaboration with GPs. NPs stated their role as unclear, lacking standards and job descriptions. The NPs experienced that some GPs were uncertain about the NPs competence, which inhibited collaboration and restricted the NPs utilization of their full capability.NPs experienced a higher degree of collaboration with GPs they knew, and they indicated that trust was the key to facilitate collaboration. The NPs also noted the challenges of establishing relationships with GPs due to the lack of formal meetings and the physical separation of their workplaces. CONCLUSION Interpersonal dynamics, organizational structures and systemic frameworks influenced the collaboration between GPs and NPs in homecare services. Trust was identified as an important prerequisite for collaboration.
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Affiliation(s)
| | - Mette Tøien
- University of South-Eastern Norway, Drammen, Norway
| | - Linn Hege Førsund
- University of South-Eastern Norway, Drammen, Norway
- Western Norway University of Applied Sciences, Førde, Norway
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Hagen TP, Zelko E. Exploring End-of-Life Care for Patients with Breast Cancer, Dementia or Heart Failure: A Register-Based Study of Individual and Institutional Factors. Healthcare (Basel) 2024; 12:943. [PMID: 38727500 PMCID: PMC11083566 DOI: 10.3390/healthcare12090943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/18/2024] [Accepted: 05/02/2024] [Indexed: 05/13/2024] Open
Abstract
OBJECTIVE To examine variations in end-of-life care for breast cancer, heart failure, and dementia patients. DATA AND METHODS Data from four Norwegian health registries were linked using a personal identification number. Longitudinal trends over 365 days and the type of care on the final day of life were analyzed using descriptive techniques and logistic regression analysis. RESULTS Patients with dementia were more commonly placed in nursing homes than patients in the two other groups, while patients with heart failure and breast cancer were more frequently hospitalized than the dementia patients. Breast cancer and heart failure patients had a higher likelihood of dying at home than dementia patients. The higher the number of general practitioners, the higher was the probability of home-based end-of-life care for cancer patients, while an increasing non-physician healthcare workers increased the likelihood of home-based care for the other patient groups. CONCLUSIONS Diagnoses, individual characteristics, and service availability are all associated with the place of death in end-of-life care. The higher the availability of health care services, the higher also is the probability of ending the life at home.
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Affiliation(s)
- Terje P. Hagen
- Department of Health Management and Health Economics, University of Oslo, Blindern, P.O. Box 1072, 0316 Oslo, Norway
| | - Erika Zelko
- Institute of General Medicine, Johannes Kepler University, Altenberger Straße 69, 4040 Linz, Austria;
- Institute of Palliative Medicine, Medical Faculty, University Maribor, Slomskov trg 15, 2000 Maribor, Slovenia
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Volungholen Sollid MI, Slaaen M, Danielsen S, Eilertsen G, Kirkevold Ø. Patient-Reported Experiences and Associated Factors in a Norwegian Radiotherapy Setting: An Explorative Cross-Sectional Study. SAGE Open Nurs 2024; 10:23779608241233868. [PMID: 38406180 PMCID: PMC10893778 DOI: 10.1177/23779608241233868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 01/04/2024] [Accepted: 01/25/2024] [Indexed: 02/27/2024] Open
Abstract
Introduction Radiotherapy is the main treatment modality in cancer. There is sparse knowledge on how patients with cancer experience their radiotherapy trajectory, and which factors might be associated with patients' experiences. Objectives The aim of the present study was to explore how adults with cancer receiving radiotherapy evaluate the quality of their care, utilizing a patient-reported experience measure, and how patient- and service-related characteristics are associated with their evaluation. Methods An explorative cross-sectional study using a self-completed questionnaire to assess patients' radiotherapy experiences was performed. Participants were recruited consecutively, within their last week of treatment, from two different hospitals in Norway from January 2021 to January 2022. Four hundred and eighty paper questionnaires were distributed to recruited patients, 240 at each hospital. Questionnaires were self-completed at home and returned by mail. The instrument person-centered coordinated care experience questionnaire (P3CEQ) was used. In addition to this, participants completed the European Organization of Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30) and The Sense of Coherence 13 scale (SOC-13). Data were analyzed using descriptive statistics, parametric tests, and unadjusted/adjusted linear regression models were estimated. Results The study included 373 patients. Patients evaluated quality of care in terms of P3CEQ scores, with a mean score of 19.5 (standard deviation = 5.4). Lowest scores were identified in areas concerning person-centeredness and service coordination. There were no significant differences in P3CEQ scores between the younger and older groups. Having a partner and better SOC-13 scores were independently associated with the overall patient-reported experience score, whereas age was not. Conclusion Patient-reported experience scores indicate that improvements are needed in some areas, such as informing and involving patients in the planning and coordination of their care. Findings suggest paying special attention to patients without a partner to offer patients the best possible care.
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Affiliation(s)
- May Ingvild Volungholen Sollid
- Research Centre for Age Related Functional Decline and Diseases, Innlandet Hospital Trust, Ottestad, Norway
- Department of Health Sciences, Norwegian University of Science and Technology (NTNU) Gjøvik, Faculty of Medicine and Health Sciences, Gjøvik, Norway
| | - Marit Slaaen
- Research Centre for Age Related Functional Decline and Diseases, Innlandet Hospital Trust, Ottestad, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Blindern, Oslo, Norway
| | - Signe Danielsen
- Department of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Physics, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Grethe Eilertsen
- USN Research Group of Older Peoples' Health, Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen G, Norway
- Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen G, Norway
| | - Øyvind Kirkevold
- Research Centre for Age Related Functional Decline and Diseases, Innlandet Hospital Trust, Ottestad, Norway
- Department of Health Sciences, Norwegian University of Science and Technology (NTNU) Gjøvik, Faculty of Medicine and Health Sciences, Gjøvik, Norway
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
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Ervik B, Dønnem T, Johansen ML. Dying at "home" - a qualitative study of end-of-life care in rural Northern Norway from the perspective of health care professionals. BMC Health Serv Res 2023; 23:1359. [PMID: 38053081 DOI: 10.1186/s12913-023-10329-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 11/14/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND 'Most patients want to die at home' is a familiar statement in palliative care. The rate of home deaths is therefore often used as a success criterion. However, providing palliative care and enabling patients to die at home in rural and remote areas may be challenging due to limited health care resources and geographical factors. In this study we explored health care professionals' experiences and reflections on providing palliative care to patients at the end of life in rural Northern Norway. METHODS This is a qualitative focus group and interview study in rural Northern Norway including 52 health care professionals. Five uni-professional focus group discussions were followed by five interprofessional focus group discussions and six individual interviews. Transcripts were analysed thematically. RESULTS Health care professionals did their utmost to fulfil patients' wishes to die at home. They described pros and cons of providing palliative care in rural communities, especially their dual roles as health care professionals and neighbours, friends or even relatives of patients. Continuity and carers' important contributions were underlined. When home death was considered difficult or impossible, nurses expressed a pragmatic attitude, and the concept of home was extended to include 'home place' in the form of local health care facilities. CONCLUSIONS Providing palliative care in patients' homes is professionally and ethically challenging, and health care professionals' dual roles in rural areas may lead to additional pressure. These factors need to be considered and addressed in discussions of the organization of care. Nurses' pragmatic attitude when transfer to a local health care facility was necessary underlines the importance of building on local knowledge and collaboration. Systematic use of advance care planning may be one way of facilitating discussions between patients, family carers and health care professionals with the aim of achieving mutual understanding of what is feasible in a rural context.
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Affiliation(s)
- Bente Ervik
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway
| | - Tom Dønnem
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - May-Lill Johansen
- Research Unit for General Practice, Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, N-9037, Norway.
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Devik SA, Lersveen GL. Specialist and Primary Physicians' Experiences and Perspectives of Collaboration While Caring for Palliative Patients-A Qualitative Study. Healthcare (Basel) 2023; 11:2188. [PMID: 37570428 PMCID: PMC10419283 DOI: 10.3390/healthcare11152188] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/27/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
Increasing numbers of people living with chronic and life-limiting diseases are actualising a greater need for palliative care. Physicians are an important provider for identifying the need for palliation, and effective follow-up requires physician collaboration across different service levels. This study aimed to explore and describe how physicians in hospitals and municipalities experience their roles and interactions in the care of palliative patients. Pair interviews were performed with seven physicians working in hospitals, primary care and nursing homes in Mid-Norway. Systematic text condensation was used to analyse the data, resulting in three main themes: The boundaries of palliative care, Alternating understandings of roles and Absence of planning. The physicians' interactions with palliative patients appeared as a fragmented distribution of tasks rather than a real collaboration with shared responsibility. At both levels, the physicians seemed to assume withdrawn roles as a reaction to unclear and unspoken expectations and to avoid interfering with others' responsibilities. Moreover, their understanding of palliative care and which groups should be included varied. Realising a collaboration between physicians that is beneficial for both patients and physicians, greater openness and real arenas for discussion and decision-making support are required.
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Affiliation(s)
- Siri Andreassen Devik
- Centre for Care Research, Mid-Norway, Faculty of Nursing and Health Sciences, Nord University, 8026 Bodø, Norway
| | - Gunhild Lein Lersveen
- Centre for Development of Institutional and Home Care Services in Trøndelag, 7650 Verdal, Norway;
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Näppä U, Nässén E, Winqvist I. Palliative care in rural areas - collaboration between district nurses and doctors: an interview study. BMC Palliat Care 2023; 22:73. [PMID: 37322520 DOI: 10.1186/s12904-023-01190-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 06/03/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Palliative care requires major nursing interventions as well as medical interventions; thus, both district nurses and doctors are vital to the palliative team. Sparsely populated rural areas are characterised by large geographic distances with the nurses and doctors located far away from each other. If collaboration does not work, this can create challenges for district nurses when managing patients' symptoms. The aim of this study was to describe district nurses' experiences of collaborating with doctors-in-charge during palliative home care in sparsely populated rural areas. METHOD Semi-structured interviews were conducted with 10 district nurses. Inductive content analysis was used to analyse the data. RESULTS The experiences of the district nurses are described under the overarching theme of Experiences of acting as the patient's advocate, which is divided into two categories: Feeling secure in oneself and the other person and Feeling alone when collaboration breaks down. CONCLUSION Consensus and coherence, or lack thereof, between district nurses and doctors affect how collaboration is experienced. Positive experiences are generated when the district nurse and the doctor share a holistic approach, while collaboration is experienced as dysfunctional when the doctor's decisions are not consistent with what the nurse judges to be beneficial to the patient. An understanding of how collaboration across long distances is experienced in rural areas is necessary to enhance collaboration.
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Affiliation(s)
- Ulla Näppä
- Department of Health Sciences, Mid Sweden University, Östersund, Sweden.
| | - Elin Nässén
- Department of Surgery, Östersund Hospital, Östersund, Sweden
| | - Idun Winqvist
- Department of Health Sciences, Mid Sweden University, Östersund, Sweden
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Pereira AG, Linzer M, Berry LL. Mitigating Moral Injury for Palliative Care Clinicians. Palliat Med Rep 2023; 4:24-27. [PMID: 36910450 PMCID: PMC9994438 DOI: 10.1089/pmr.2022.0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2023] [Indexed: 02/18/2023] Open
Abstract
Palliative care clinicians (PCCs) in the United States face the combination of increasing burnout and a growing need for their services based on demographic changes and an increasing burden of serious illness. In addition to efforts to increase the number of PCCs and to train other clinicians in "primary palliative skills," we must address the burnout in the field to address the growing gap between need for this care and capacity to provide it. To address burnout in PCCs, we must develop solutions with the unique contributors to burnout in this field in mind. PCCs are particularly susceptible to moral distress and moral injury faced by all clinicians, and these states are inextricably linked to burnout. We propose three solutions to address moral distress and moral injury in PCCs to reduce burnout. These solutions are grounded in the dilemmas particular to palliative care and in best evidence: first, to create space for PCCs to confront moral challenges head-on; second, to integrate ethics consultations into care of some patients cared for by PCCs; and third, to reassess care models for PCCs. These approaches can mitigate burnout and thus address the growing gap in our ability to provide high-quality palliative care for those patients in need.
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Affiliation(s)
- Anne G Pereira
- Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota, USA.,Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Mark Linzer
- Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota, USA.,Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Leonard L Berry
- Mays Business School, Texas A&M University, College Station, Texas, USA.,Institute for Healthcare Improvement, Cambridge, Massachusetts, USA
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Fordjour GA, Chow AYM. Global Research Trend and Bibliometric Analysis of Current Studies on End-of-Life Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11176. [PMID: 36141446 PMCID: PMC9517393 DOI: 10.3390/ijerph191811176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/22/2022] [Accepted: 09/03/2022] [Indexed: 06/16/2023]
Abstract
The growing emphasis on evidence-based practice has led to a need for more research on healthcare disciplines, and for the synthesis and translation of that research into practice. This study explored the global research trend in regard to End-of-Life Care (EoLC), and assessed the impact and influence, on the scientific community, of relevant EoLC publications EoLC. Over 350,000 related publications on EoLC were retrieved from three databases (PubMed, Scopus, and Web of Science). Our analysis of the global research trend revealed an exponential rise in the number of related publications on EoLC since the year 1837. This study assessed the bibliometric information of 547 current journal publications on EoLC, sorted by relevance, from the three databases. The USA (47.3%) and the UK (16.1%) were the most productive countries, in terms of the number of relevant publications. The bibliometric analysis also revealed which EoLC research was most impactful and influential, from different parameters including documents, authors, sources, and organisations. The keyword analysis further suggested the growing importance of advance care planning and decision-making in regard to EoLC, as well as an episodic upsurge of EoLC publications related to the COVID-19 pandemic. There were few collaborations among the prolific research on EoLC. This study recommends increased research collaboration across the globe, for wider wisdom-sharing on EoLC issues.
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Affiliation(s)
| | - Amy Yin Man Chow
- Jockey Club End-of-Life Community Care Project, The University of Hong Kong, Hong Kong
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
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Fasting A, Hetlevik I, Mjølstad BP. Finding their place - general practitioners' experiences with palliative care-a Norwegian qualitative study. BMC Palliat Care 2022; 21:126. [PMID: 35820894 PMCID: PMC9277777 DOI: 10.1186/s12904-022-01015-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/28/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Modern palliative care focuses on enabling patients to spend their remaining time at home, and dying comfortably at home, for those patients who want it. Compared to many European countries, few die at home in Norway. General practitioners' (GPs') involvement in palliative care may increase patients' time at home and achievements of home death. Norwegian GPs are perceived as missing in this work. The aim of this study is to explore GPs' experiences in palliative care regarding their involvement in this work, how they define their role, and what they think they realistically can contribute towards palliative patients. METHODS We performed focus group interviews with GPs, following a semi-structured interview guide. We included four focus groups with a total of 25 GPs. Interviews were recorded and transcribed verbatim. We performed qualitative analysis on these interviews, inspired by interpretative phenomenological analysis. RESULTS Strengths of the GP in the provision of palliative care consisted of characteristics of general practice and skills they relied on, such as general medical knowledge, being coordinator of care, and having a personal and longitudinal knowledge of the patient and a family perspective. They generally had positive attitudes but differing views about their formal role, which was described along three positions towards palliative care: the highly involved, the weakly involved, and the uninvolved GP. CONCLUSION GPs have evident strengths that could be important in the provision of palliative care. They rely on general medical knowledge and need specialist support. They had no consensus about their role in palliative care. Multiple factors interact in complex ways to determine how the GPs perceive their role and how involved they are in palliative care. GPs may possess skills and knowledge complementary to the specialized skills of palliative care team physicians. Specialized teams with extensive outreach activities should be aware of the potential they have for both enabling and deskilling GPs.
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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, Kristiansund, 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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