Perceived role of the family physician in early palliative home care for patients with a chronic life-limiting disease: a qualitative study with family physicians, community nurses and patients.

Background: Patients with a life-limiting illness may experience palliative care needs. While palliative care (PC) has been mostly regarded as a health care service for the final phase of life, usually provided by specialized health professionals, it is now assumed to be relevant in earlier stages and an important role is assigned to family physicians (FPs). However, the delineation of their role in (early) PC remains vague.
Aim: To explore views from FPs, community nurses and patients about the roles and tasks of the FP in PC for patients with a life-limiting disease from diagnosis onward.
Methods: We performed 18 interviews with patients with cancer, organ failure or dementia and 6 focus groups (4 with FPs and 2 with community nurses). Data were recorded, transcribed and thematic analysis was performed.
Findings: We found four roles for FPs in PC applicable throughout the disease trajectory of their patients: 1) health promoter, 2) care coordinator, 3) communicator and 4) scholar committed to improve PC competencies. Important tasks were attributed to FPs at different stages: (1) at diagnosis the FP needs to clarify the specialist's explanation about the disease and treatments; (2) during treatment the FP should survey the patient's body functions and medication use so as to check whether the patient needs further psychosocial, practical, existential care or the family needs support. FPs should start arranging advance directives; (3) After exacerbations the FP should check if additional home care is needed; (4) In the terminal phase, the FP should inform the patient and family about the impending death. The collaboration with palliative home care teams can be initiated by the FP.
Conclusion: FPs, community nurses and patients perceive specific roles and tasks for the FP in PC. Our results help to define the professional competencies needed for early PC, but also help building an integrated model of family practice, hospital practice and PC.