Abstract
BackgroundProviding end of life care (EoLC) is an important aspect of primary care, which reduces the risk of hospital admission for most patients. However, general practitioners (GPs) seem to have low confidence in their ability to provide EoLC. Little is known about an adequate volume and kind of training in EoLC among GP trainees.MethodsWe performed a before-after comparison in all post-graduate GP trainees who were registered in the vocational training program (KWBW VerbundweiterbildungPLUS). They were offered participation within a two-day seminar focussing on palliative care in 2017. Those who attended the seminar (intervention group I) completed a paper-based questionnaire directly before the intervention (T1) and 6 months after (T2). None-attendees (group C) were also asked to fill out the questionnaire once. The questionnaire covered previous experiences in palliative care, self-assessment of competencies in EoLC in the organisation of patient care as well as in control of symptoms, attitudes towards death and caring for dying patients and questions about GPs’ role in EoLC.ResultsIn total, 294 GP trainees (I: n = 219; C: n = 75) participated in the study. Of those, more than 90% had previously gained experience in EoLC mainly during vocational training in the hospital rotation. Around a third had previously gained competencies in EoLC in medical school. Between groups I (T1) and C no significant differences were observed in socio-demographic characteristics, pre-existing experience or overall expertise. At T2, 75% of participants of group I declared they have extended their competencies in EoLC after the intervention and 70% classified the intervention as helpful or very helpful. Overall, they rated their competencies significantly higher than at T1 (p < 0.01). In detail, competencies in organisation of EoLC and competencies in handling of symptoms significantly improved (p < 0.01). Due to the intervention, 66% could reflect their attitudes towards dying, death and grief and 18% changed their attitudes. Group I highlighted palliative care as one of GPs tasks (Likert 4.47/5, SD 0.75).ConclusionsThe intervention fostered personal competencies, understanding and self-confidence in EoLC among GP trainees. This is crucial for the aim to broadly provide EoLC.
Highlights
Providing end of life care (EoLC) is an important aspect of primary care, which reduces the risk of hospital admission for most patients
Providing primary care incorporates end of life care (EoLC): Less than half of the patients in Europe die at home [1] but clearly more would prefer to die at home [2, 3]
Setting All General practice (GP) trainees registered in the post-graduate training program KWBW VerbundweiterbildungPLUS [22, 24] were offered participation within a two-day seminar focussing on palliative care in 2017
Summary
Providing end of life care (EoLC) is an important aspect of primary care, which reduces the risk of hospital admission for most patients. A minority of patients (10–15%) need intense EoLC due to complex problems [5, 6] If these patients wish to die at home, specialised ambulatory palliative care (SAPC) ensures the delivery of EoLC and increases quality of life outside the hospital in Germany [7]. GPs have shown to reduce hospital admissions by providing generalist palliative care for most of the patients by ensuring coordination with family carers, community health providers and other physicians [8,9,10,11]. To ensure comprehensive EoLC is an increasing task for many individuals, and especially for family carers, for community healthcare providers and for GPs
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