Date Published: February 1, 2017
Publisher: Public Library of Science
Author(s): Stéphanie Giezendanner, Corinna Jung, Hans-Ruedi Banderet, Ina Carola Otte, Heike Gudat, Dagmar M. Haller, Bernice S. Elger, Elisabeth Zemp, Klaus Bally, Angel M. Foster.
Identifying essential competencies in end-of-life care, as well as general practitioners’ (GPs) confidence in these competencies, is essential to guide training and quality improvement efforts in this domain.
To determine which competencies in end-of-life care are considered important by GPs, to assess GPs’ confidence in these competencies in a European context and their reasons to refer terminally ill patients to a specialist.
Cross-sectional postal survey involving a stratified random sample of 2000 GPs in Switzerland in 2014.
Survey development was informed by a previous qualitative exploration of relevant end-of-life GP competencies. Main outcome measures were GPs’ assessment of the importance of and confidence in 18 attributes of end-of-life care competencies, and reasons for transferring care of terminally-ill patients to a specialist. GP characteristics associated with main outcome measures were tested using multivariate regression models.
The response rate was 31%. Ninety-nine percent of GPs considered the recognition and treatment of pain as important, 86% felt confident about it. Few GPs felt confident in cultural (16%), spiritual (38%) and legal end-of-life competencies such as responding to patients seeking assisted suicide (35%) although more than half of the respondents regarded these competencies as important. Most frequent reasons to refer terminally ill patients to a specialist were lack of time (30%), better training of specialists (23%) and end-of-life care being incompatible with other duties (19%). In multiple regression analyses, confidence in end-of-life care was positively associated with GPs’ age, practice size, home visits and palliative training.
GPs considered non-somatic competencies (such as spiritual, cultural, ethical and legal aspects) nearly as important as pain and symptom control. Yet, few GPs felt confident in these non-somatic competencies. These findings should inform training and quality improvement efforts in this domain, in particular for younger, less experienced GPs.
The European Association for Palliative Care recently described the core competencies of palliative care encompassing health professionals’ abilities to meet patient’s physical, social, psychological and spiritual needs . However, most of the existing quality indicators of palliative care fall within the domain of physical care . As a consequence, relatively little is known about health professionals’ attitudes towards a broad range of end-of-life care (EOLC) competencies. Since general practitioners (GPs) play an increasingly important role in palliative and end-of-life care their perspective is particularly important [3, 4].
The majority of GPs felt non-somatic competencies (e.g. legal, ethical, cultural and spiritual competencies) were nearly as important as somatic competencies (e.g. pain and symptom control). Yet, they felt less confident in managing legal, ethical, cultural and spiritual aspects of end-of-life care. Older age, a higher number of home visits and the completion of palliative care training were positively associated with GPs’ confidence to provide palliative care. Lack of time, better training of specialists and incompatibility with other duties were the most frequently reported reasons for referring terminally ill patients to a specialist.