Abstract
BackgroundPrimary care physicians (General Practitioners (GPs)) play a pivotal role in providing end of life care (EoLC). However, many lack confidence in this area, and the quality of EoLC by GPs can be problematic. Evidence regarding educational needs, learning preferences and the acceptability of evaluation methods is needed to inform the development and testing of EoLC education. This study therefore aimed to explore GPs’ EoLC educational needs and preferences for learning and evaluation.MethodsA qualitative focus group study was conducted with qualified GPs and GP trainees in the UK. Audio recordings were transcribed and analysed thematically. Expert review of the coding frame and dual coding of transcripts maximised rigour.ResultsTwenty-eight GPs (10 fully qualified, 18 trainees) participated in five focus groups. Four major themes emerged: (1) why education is needed, (2) perceived educational needs, (3) learning preferences, and (4) evaluation preferences. EoLC was perceived as emotionally and clinically challenging. Educational needs included: identifying patients for palliative care; responsibilities and teamwork; out-of-hours care; having difficult conversations; symptom management; non-malignant conditions; and paediatric palliative care. Participants preferred learning through experience, working alongside specialist palliative care staff, and discussion of real cases, to didactic methods and e-learning. 360° appraisals and behavioural assessment using videoing or simulated interactions were considered problematic. Self-assessment questionnaires and patient and family outcome measures were acceptable, if used and interpreted correctly.ConclusionsGPs require education and support in EoLC, particularly the management of complex clinical care and counselling. GPs value mentoring, peer-support, and experiential learning alongside EoLC specialists over formal training.
Highlights
Primary care physicians (General Practitioners (GPs)) play a pivotal role in providing end of life care (EoLC)
Why education is needed All participants recognised the importance and relevance of EoLC: ‘Generalists should be specialists in end of life care because we are the coordinators at the end.’ (GP04)
One GP felt that training was not the answer to improving EoLC: ‘The training model is one that I would question, because I don’t think we can train people to do these things
Summary
Primary care physicians (General Practitioners (GPs)) play a pivotal role in providing end of life care (EoLC). This study aimed to explore GPs’ EoLC educational needs and preferences for learning and evaluation. Working in Clinical Commissioning Groups (CCGs) with other practices, GPs are key players in making the wider systemic changes required to improve EoLC [5] and help shift care from hospitals to the community, in line with patient wishes [6, 7]. A systematic review of palliative care delivery by GPs found that many GPs feel ill-prepared and lack confidence in EoLC, despite being considered vital players in its delivery, and despite valuing this part of their work [9]. Policy guidance is right to recognise the urgent need for evidence-based education in EoLC for GPs [5, 18]
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