Tasks of the Family Physician in Early Palliative Home Care for Patients with a Chronic Life-Limiting Disease as Perceived by Family Physicians, Community Nurses, and Patients: A Qualitative Study

Background: Patients with a life-limiting illness usually experience palliative care needs. While palliative care has been mostly regarded as a health care service for the final phase of life, usually provided by specialist 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 palliative care remains vague.
Aim: To explore the opinions from FPs, community nurses and patients about the tasks of the FP in palliative care for patients with a life-limiting disease from diagnosis onwards.
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). A thematic content analysis was used to categorize the tasks of FPs into themes, with special attention not only to focus on the terminal phase.
Findings: The palliative care tasks of FPs could be categorized into four "stages" of the disease course: 1) around diagnosis the FP is expected clarify the specialist's explanation about the disease and treatments; 2) during treatment the FP should do follow up and check whether the patient needs further psychosocial, practical, existential care or the family needs support and start arranging advanced directives; 3) around acute episodes or exacerbations FP should check if additional home care is needed, and 4) during 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. FPs, community nurses and patients mostly have the same opinions about the tasks of the FP in palliative care. Exceptions mostly relate to dementia patients.
Conclusion: Our results help to define the professional competencies needed for early PC, but also help building an integrated model of general practice, hospital practice and PC.