'It is not the fading candle that one expects': general practitioner's perspectives on life-preserving versus 'letting go' decision-making in end-of-life home care
Background: Many general practitioners (GPs) are willing to provide end-of-life (EoL) home care for their patients. International research on GPs' approach to care in patients' final weeks of life showed a combination of palliative measures with life-preserving actions. Aim: To explore the GP's perspective on life-preserving versus letting go decision-making in EoL home care. Design: Qualitative analysis of semi-structured interviews with 52 Belgian GPs involved in EoL home care. Results: Nearly all GPs adopted a palliative approach and an accepting attitude towards death. The erratic course o... Mehr ...
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Dokumenttyp: | journalarticle |
Erscheinungsdatum: | 2015 |
Schlagwörter: | Medicine and Health Sciences / letting go / hospice care / terminal care / PALLIATIVE CARE / home care / general practitioner / general practice / family physician / end-of-life care / decision-making / Belgium / CANCER-PATIENTS / DEATH / OPPORTUNITIES / TRANSITIONS / CHALLENGES / PLACE |
Sprache: | Englisch |
Permalink: | https://search.fid-benelux.de/Record/base-26981486 |
Datenquelle: | BASE; Originalkatalog |
Powered By: | BASE |
Link(s) : | https://biblio.ugent.be/publication/7019665 |
Background: Many general practitioners (GPs) are willing to provide end-of-life (EoL) home care for their patients. International research on GPs' approach to care in patients' final weeks of life showed a combination of palliative measures with life-preserving actions. Aim: To explore the GP's perspective on life-preserving versus letting go decision-making in EoL home care. Design: Qualitative analysis of semi-structured interviews with 52 Belgian GPs involved in EoL home care. Results: Nearly all GPs adopted a palliative approach and an accepting attitude towards death. The erratic course of terminal illness can challenge this approach. Disruptive medical events threaten the prospect of a peaceful end-phase and death at home and force the GP either to maintain the patient's (quality of) life for the time being or to recognize the event as a step to life closure and letting the patient go. Making the right decision was very difficult. Influencing factors included: the nature and time of the crisis, a patient's clinical condition at the event itself, a GP's level of determination in deciding and negotiating letting go and the patient's/family's wishes and preparedness regarding this death. Hospitalization was often a way out. Conclusions: GPs regard alternation between palliation and life-preservation as part of palliative care. They feel uncertain about their mandate in deciding and negotiating the final step to life closure. A shortage of knowledge of (acute) palliative medicine as one cause of difficulties in letting-go decisions may be underestimated. Sharing all these professional responsibilities with the specialist palliative home care teams would lighten a GP's burden considerably.