General practitioners' considerations when deciding whether to initiate end-of-life conversations: a qualitative...

Area of Science:

• Palliative Care
• General Practice
• Medical Communication

Background:

• End-of-life (EOL) discussions are often delayed until near death, even with life-limiting conditions.
• Doctors may avoid explicit EOL communication, focusing instead on comfort care, limiting patient planning.
• General Practitioners (GPs) play a crucial role in managing patients approaching the end of life.

Purpose of the Study:

• To investigate the decision-making processes of GPs regarding the initiation of EOL discussions.
• To understand the factors influencing GPs' timing and approach to EOL conversations.

Main Methods:

• Qualitative study utilizing semi-structured interviews.
• Purposive sampling of 15 GPs and GP trainees in South-East Queensland, Australia.
• Inductive thematic analysis of interview transcripts.

Main Results:

• Australian GPs acknowledge a responsibility to initiate EOL conversations and recognize specific triggers.
• GPs express caution in broaching sensitive EOL topics due to various patient, family, cultural, and personal considerations.
• Identified barriers include anticipated patient reactions, cultural norms, societal taboos, family dynamics, and personal challenges for doctors.

Conclusions:

• Findings support developing strategies to help GPs initiate EOL discussions effectively.
• Approaches should acknowledge GPs' sense of duty and the complexities influencing their caution.
• Addressing factors like patient response, cultural sensitivity, and personal challenges can improve EOL communication.