Sven Schwabe1, Gülay Ates2, Benjamin Ewert3, Jeroen Hasselaar4, Michaela Hesse2, Lisa Linge-Dahl2, Birgit Jaspers2,5, Lukas Radbruch2,6. 1. Klinik und Poliklinik für Palliativmedizin, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Deutschland. Sven.Schwabe@ukb.uni-bonn.de. 2. Klinik und Poliklinik für Palliativmedizin, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Deutschland. 3. Heidelberg School of Education, Universität Heidelberg, Heidelberg, Deutschland. 4. Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre Nijmegen, Nijmegen, Niederlande. 5. Klinik für Palliativmedizin, Universitätsmedizin Göttingen, Göttingen, Deutschland. 6. Zentrum für Palliativmedizin, Malteser Krankenhaus Seliger Gerhard, Bonn/Rhein-Sieg, Deutschland.
Abstract
BACKGROUND: The outpatient medical care of palliative patients (PPs) has always fallen within the duties of general practitioners. Since the specialized palliative out-patient care (SAPV) legislation in 2007 palliative home care teams (PCTs) were established, providing holistic medical, nursing, and psychosocial support for patients with life-limiting illness and their care providers. OBJECTIVES: The article explores the role of GPs in palliative home care settings with PCTs from the patient's perspective. MATERIALS AND METHODS: From December 2014 to January 2015 we conducted 23 qualitative, semi-structured interviews with severely ill patients receiving specialist palliative care at home in Germany. The theory-based analysis followed the qualitative content analysis according to Mayring. RESULTS: The expectations of PPs towards their GP in integrated palliative care were influenced by individual criteria such as availability, intensity and duration of the doctor-patient-relationship. In relation to the quality of the long-term relationship and more specifically for basic medical care GPs still play an important role. On the other hand, PCTs are becoming increasingly important. In addition to the pain-management and symptom control responsibilities, they meet the daily care needs of PPs and their caregivers by coordinating the care network as well as providing psychosocial support and 24/7-care. CONCLUSIONS: Shifting of traditional tasks from GPs to PCTs influences the role of the GP. PCTs can unburden the GP from unrealistic expectations and improve the patients' quality of life. However, this leads to a tendency for reduced importance of the GP.
BACKGROUND: The outpatient medical care of palliative patients (PPs) has always fallen within the duties of general practitioners. Since the specialized palliative out-patient care (SAPV) legislation in 2007 palliative home care teams (PCTs) were established, providing holistic medical, nursing, and psychosocial support for patients with life-limiting illness and their care providers. OBJECTIVES: The article explores the role of GPs in palliative home care settings with PCTs from the patient's perspective. MATERIALS AND METHODS: From December 2014 to January 2015 we conducted 23 qualitative, semi-structured interviews with severely ill patients receiving specialist palliative care at home in Germany. The theory-based analysis followed the qualitative content analysis according to Mayring. RESULTS: The expectations of PPs towards their GP in integrated palliative care were influenced by individual criteria such as availability, intensity and duration of the doctor-patient-relationship. In relation to the quality of the long-term relationship and more specifically for basic medical care GPs still play an important role. On the other hand, PCTs are becoming increasingly important. In addition to the pain-management and symptom control responsibilities, they meet the daily care needs of PPs and their caregivers by coordinating the care network as well as providing psychosocial support and 24/7-care. CONCLUSIONS: Shifting of traditional tasks from GPs to PCTs influences the role of the GP. PCTs can unburden the GP from unrealistic expectations and improve the patients' quality of life. However, this leads to a tendency for reduced importance of the GP.
Entities:
Keywords:
General practitioner; Integrated palliative care; Outpatients; Palliative care team; Qualitative methods
Authors: K Stichling; M Krause; B Ditscheid; M Hach; M Jansky; M Kaufmann; T Lehmann; W Meißner; F Nauck; W Schneider; S Schulz; H C Vollmar; U Wedding; J Bleidorn; A Freytag Journal: BMC Palliat Care Date: 2020-08-03 Impact factor: 3.234