Background
Methods
Search strategy and sources
Study selection
Inclusion of studies
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1. Studies published in English between March 2012 and March 2022, based on original qualitative data (mixed methods studies were included if the qualitative element contributed data about GPs’ experiences with palliative care).
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2. Studies exploring the views and experiences of GPs, other healthcare professionals, patients, and their relatives on roles, tasks and approaches of GPs enabling palliative care, without interest in one specific diagnosis, training or education, and after the identification of palliative care needs.
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3. Studies had to have health care systems in which the GP is the first point of contact and thereby act as a gatekeeper to specialist care, including specialized palliative care.
Quality assessment
Data extraction and synthesis of results
Results
Study selection
Study characteristics
First author with reference | Year of publication | Country (ISO 3) | Study objectives | Study description | No. of participants | Description of participants | Methodology and analysis |
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Beernaert et al. [28] | 2015 | BEL | To explore the views of family physicians, nurses, and patients about the tasks of the family physician in palliative care for people with a life-limiting illness from diagnosis onwards | Focus groups and semi-structured interviews | 50 | 18 interviews with patients 6 focus groups, 4 with FPs (n = 20) and 2 with community nurses (n = 12) | Thematic content analysis |
Cardoso et al. [29] | 2021 | PRT | To understand the perspectives of specialist and trainee family physicians about their role in palliative care | Focus groups | 19 | Two focus groups; one with 10 family physician trainees and one with 9 family physicians | Thematic analysis |
Geiger et al. [30] | 2016 | DEU | To explore the tasks and challenges regarding the care for frail older patients in the last phase of life from the GPs’ point of view, and the latter’s perception of their own role and responsibilities | Semi-structured interviews | 14 | GPs | Grounded Theory |
Herrmann et al. [31] | 2019 | AUS | To explore Australian GPs’ perceptions of barriers and enablers to the provision of palliative care and provides new insights into how to implement best practice care at the end of life | Semi-structured interviews | 25 | GPs | Content analysis |
Herrmann et al. [32] | 2019 | AUS | To explore, in a sample of Australian GPs, their perceptions of best practice palliative care and their ideal role in its delivery | Semi-structured interviews | 25 | GPs | Content analysis |
McCallan et al. [33] | 2021 | CAN | To (1) explore the barriers family physicians encounter in providing palliative and end-of-life care in our metropolitan context and (2) identify potential strategies to overcome these challenges | Interviews | 10 | Family physicians | Thematic analysis |
Mitchell et al. [34] | 2016 | GBR | To provide insight into the experience of GPs providing End-of-Life care in the community, particularly the facilitators and barriers to good-quality care | Questionnaire survey | 516 | GPs | Descriptive statistics and thematic analysis |
Rewegan et al. [35] | 2019 | CAN | To explore how a palliative approach to care is operationalized in primary care, through the description of clinical practices used by primary care clinicians to identify and care for patients with progressive life-limiting illness (PLLI) | Semi-structured interviews | 11 | 6 physicians, 3 nurse practitioners, 1 registered nurse, and 1 registered practical nurse | Content analysis |
Sharp et al. [36] | 2018 | GBR | To investigate the attitudes of GPs to advance care planning discussions with frail and older individuals | Focus groups | 21 | GPs | Framework analysis |
Silveira et al. [37] | 2012 | USA | To explore the factors influencing primary care providers' ability to care for their dying patients in Michigan | Focus groups | 50 | 16 focus groups; twenty-eight primary care providers and twenty-two clinical support staff | Thematic analysis |
Stiel et al. [38] | 2020 | DEU | To explore positive and negative experiences in PC in Germany from the perspectives of patients, relatives, and health care professionals in a primary care setting | Interviews | 16 | Patients, relatives, GPs, medical assistants, and nurses | Critical Incident Technique and thematic analysis |
van Baal et al. [39] | 2020 | DEU | To evaluate the quality of End-of-Life Care from a GP’s perspective using the German version of the General Practice End-of-Life Care Index | Survey and qualitative questions | 52 | GPs | Descriptive statistics and content analysis |
Quality assessment
Synthesis of results
Approaches to palliative care
“We took over a patient from a GP. And he was a patient suffering from end-stage COPD, who additionally had a pulmonary embolism and in consequence a failure of a large part of his lung. The whole hallway, the entrance area, was full of oxygen bottles and the man was lying in a small room. The man had his oxygen running at 14 litres. So we came there and slowly got to know each other. We explained everything during our talk, for a while, and we touched upon his matters. The oxygen was lowered to 4 litres. This was very impressive, that’s when we noticed this had a psychosocial component.” [38]
“We often intentionally book patients’ appointments for them, I mean, you know a lot of appointments are made when the patient perceives there’s a problem… but we often switch to intentionally booking appointments when we feel there’s discussions that need to take place around their care. [35]
Sufficient education and training
Tasks and contents of the palliative care consultation
“…Undividable part of his role as [a] doctor” (the ability to manage less complex symptoms)[29]
“They [the frail couple] are at high risk of falling, highly vulnerable to everything. […] They are supported by all the props our system has. More is not possible. It’s all in a state of fragile balance!”[30]
“Sometimes we don’t even know if the patient is informed or not [about the diagnosis], that’s the worst thing. We received phone calls saying, “Yes, yes, but my dad is not supposed to know about it [meaning end-of-life stage]”, or nope, the wife doesn’t want her husband to know, then I say, “Then we actually can’t care for him”. When we get involved, we do insist that patients are made aware. And we deal with that [palliative care] in rare cases because of the [patients’] huge distress. No one else can provide it [palliative care without patients being informed about diagnosis/prognosis], but we still do it... reluctantly. And if we were to stay at the residents’ bedside, we would speak the truth. Anything else would make no sense. Everybody should question themselves,“ [Do I want] to be fooled by my wife, husband, children [...]?”. The end is near, maybe someone wants to arrange something, perhaps you would like to put all your thoughts in order. I think you might be deprived of your life and the very last part of it, that’s a shame.” [38]
The palliative care elements surrounding the consultation
“I might not say all at once, right, we need to discuss a plan for you, but you just mention it when you might see them every 2 months or something.”[36]
“[Urgent care is] used because [patients] might not be able to get an appointment with a provider… [A problem] becomes even more urgent and they just go to urgent care.”[37]
“For some people I book regular home visits – if they’re at that point when patients are finding it difficult to come and see me, and often it is more near the end of life, but not necessarily. I had one lady who I was doing home visits for, for the last two years of life. Just because she couldn’t come and see me, so that was the best way to do it.” [35]
“(…) the fact that we are being told, does not mean we have to solve it .... We can offer paths, options or give people advice. [28]
“And we actually have very [well] qualified practice assistants who also partly take over home visits. […] And we also have three wound managers […] we are very happy, that it’s not just left to the nursing agencies, but that someone from the practice has a look at least once a week.” [30]
“That’s why I naturally make regular visits to these very old [patients], to see, when the time comes, which [of the family members] I may now also involve. Whom can I rely on? Firstly, to understand what the patients themselves want, but also to understand what concerns those standing beside them.” [30]
“Actually, (I see that) also as my obligation as a GP, because they know me and so they will then also ask for me. […] So I can’t fade away when it comes to the end!” [30]
“I tell them outright, whatever happens, good or bad, I’m going to be there for you… I am going to do my best to help you. I try to get emotionally involved, because you’re caring for people, and you’ll make better decisions because you’ll know where they’re coming from”[35]