Abstract
BackgroundFrail older people are an increasingly important group in primary care due to demographic change. For these patients, a palliative care approach may be useful to sustain the quality of life in the last phase of their lives. While general practitioners (GPs) play a key role in the primary care for older patients, general palliative care is still in its infancy and little is known in Germany about caring for frail older people towards the end of life. This study aims to explore the tasks and challenges regarding the care for frail older patients in the last phase of life from the GPs’ point of view, and the latter’s perception of their own role and responsibilities.MethodsExplorative qualitative study based on semi-structured in-depth interviews with 14 GPs from urban and rural regions in Lower Saxony, Germany. Analysis was carried out according to the principles of Grounded Theory.ResultsThe GPs’ key commitment “caring for frail older patients until the end” as an integral part of primary care was worked out as a key category, flanked by central issues: “causal conditions and challenges,” which include patients’ preconditions and care needs as well as communication and cooperation aspects on the carers’ level. “Barriers and facilitators within the health system” refers to prerequisites of the German healthcare system, such as high caseloads. Regarding “strategies to comply with this commitment”, various self-developed strategies for the care of frail older people are presented, depending on the GPs’ understanding of their professional role and individual circumstances.ConclusionsThe GPs show a strong commitment to caring for the frail older patients until the end of life. However, it is a challenging and complex task that requires significant time, which can take GPs to their limits. There is a great need to improve patient—and family-centered proactive communication, as well as interprofessional cooperation. Strengthening the team approach in primary care could relieve the burden on GPs, especially in rural areas, while simultaneously improving end-of-life care for their patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s12904-016-0124-5) contains supplementary material, which is available to authorized users.
Highlights
Frail older people are an increasingly important group in primary care due to demographic change
End-of-life care has been characterized as providing palliative care in “an extended period of one to two years during which the patient/family and health professionals become aware of the life-limiting nature of their illness” [7]
Sample Fourteen general practitioner (GP) with an average age of 48 years from different care regions in Lower Saxony participated in the study
Summary
Frail older people are an increasingly important group in primary care due to demographic change. For these patients, a palliative care approach may be useful to sustain the quality of life in the last phase of their lives. Frail older people with complex care needs as a result of demographic transition and changing disease patterns are becoming an increasingly important group for primary care [1,2,3]. The majority of frail older patients are cared for by their general practitioner (GP) in the last phase of their lives For these patients, the development of end-of-life care plans in primary care has been advocated as an important strategy [7,8,9]. End-of-life care has been characterized as providing palliative care in “an extended period of one to two years during which the patient/family and health professionals become aware of the life-limiting nature of their illness” [7].
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