Abstract
ObjectiveThis qualitative study set in the West Midlands region of the United Kingdom, aimed to examine the role of the general practitioner (GP) in children’s oncology palliative care from the perspective of GPs who had cared for a child with cancer receiving palliative care at home and bereaved parents.MethodsOne-to-one semi-structured interviews were undertaken with 18 GPs and 11 bereaved parents following the death. A grounded theory data analysis was undertaken; identifying generated themes through chronological comparative data analysis.ResultsSimilarity in GP and parent viewpoints was found, the GPs role seen as one of providing medication and support. Time pressures GPs faced influenced their level of engagement with the family during palliative and bereavement care and their ability to address their identified learning deficits. Lack of familiarity with the family, coupled with an acknowledgment that it was a rare and could be a frightening experience, also influenced their level of interaction. There was no consistency in GP practice nor evidence of practice being guided by local or national policies. Parents lack of clarity of their GPs role resulted in missed opportunities for support.ConclusionsTime pressures influence GP working practices. Enhanced communication and collaboration between the GP and regional childhood cancer centre may help address identified GP challenges, such as learning deficits, and promote more time-efficient working practices through role clarity. Parents need greater awareness of their GP’s wide-ranging role; one that transcends palliative care incorporating bereavement support and on-going medical care for family members
Highlights
Providing palliative care to adults is seen as an important component of general practitioners’ (GP’s) practice as, palliative medicine is recognized as an established specialty, it is unlikely that all patients requiring palliative care will be managed by a specialist [1]
The incidence of childhood cancer deaths and infancy of Pediatric palliative medicine (PPM) as a specialty, coupled with parental preference for their child to die within the family home [6] highlight the importance of the GPs role in this highly specialized area of clinical practice
Data saturation was achieved after 29 parents and GPs interviewed: 11 parent interviews (9 mothers, 1 father, 1 joint mother and father) and 18 GPs (Table 2)
Summary
Providing palliative care to adults is seen as an important component of general practitioners’ (GP’s) practice as, palliative medicine is recognized as an established specialty, it is unlikely that all patients requiring palliative care will be managed by a specialist [1]. Pediatric palliative medicine (PPM) is less well established than adult palliative medicine (only being recognized as a subspecialty for doctors in 2009 [2]) and providing palliative care to children often poses challenges to GPs [3]. The incidence of childhood cancer deaths and infancy of PPM as a specialty, coupled with parental preference for their child to die within the family home [6] highlight the importance of the GPs role in this highly specialized area of clinical practice
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