Early identification of palliative care needs by family physicians: a qualitative study of barriers and facilitators from the perspective of family physicians, community nurses

Background: There is a growing recognition that a palliative care approach should be initiated early and not just in the terminal phase for patients with life-limiting diseases. Family physicians (FPs) then play a central role in identifying and managing palliative care needs, but appear to not identify them accurately or in a timely manner.
Aim: To explore the barriers to and facilitators of the early identification by FPs of the palliative care needs.
Design, setting & participants: 6 focus groups (4 with FPs, n=20 and 2 with community nurses, n=12) and 18 interviews with patients with cancer, copd, heart failure and dementia were held. Thematic analysis was used to derive themes that covered barriers and facilitators.
Results: Key barriers and facilitators found relate to communication styles, the perceived role of a FP, and continuity of care. FPs do not systematically assess non-acute care needs and patients do not mention them or try to mask them from the FP. This is embedded within a predominant perception among patients, nurses and FPs of the FP as the person to appeal to in acute and standard follow-up situations rather than for palliative care needs. FPs also seemed to pay more often attention to palliative care needs of patients in a terminal phase.
Conclusion. The current practice of palliative care in Belgium is far from the presently considered ideal palliative care approaches. Facilitators such as pro-active communication and communication tools could contribute to the development of guidelines for FPs and policymakers in primary care.