Abstract
BackgroundGeneralists such as general practitioners and district nurses have been the main actors in community palliative care in Norway. Specialised oncology nurses with postgraduate palliative training are increasingly becoming involved. There is little research on their contribution. This study explores how general practitioners (GPs) and oncology nurses (ONs) experience their collaboration in primary palliative care.MethodsA qualitative focus group and interview study in rural Northern Norway, involving 52 health professionals. Five uni-professional focus group discussions were followed by five interprofessional discussions and six individual interviews. Transcripts were analysed thematically.ResultsThe ideal cooperation between GPs and ONs was as a “meeting of experts” with complementary competencies. GPs drew on their generalist backgrounds, including their often long-term relationship with and knowledge of the patient. The ONs contributed longitudinal clinical observations and used their specialised knowledge to make treatment suggestions. While ONs were often experienced and many had developed a form of pattern recognition, they needed GPs’ competencies for complex clinical judgements. However, ONs sometimes lacked timely advice from GPs, and could feel left alone with sick patients. To avoid this, some ONs bypassed GPs and contacted palliative specialists directly.While traditional professional hierarchies were not a barrier, we found that organization, funding and remuneration were significant barriers to cooperation. GPs often did not have time to meet with ONs to discuss shared patients. We also found that ONs and GPs had different strategies for learning. While ONs belonged to a networking nursing collective aiming for continuous quality improvement, GPs learned mostly from their individual experience of caring for patients.ConclusionsThe complementary competences and autonomous roles of a specialised nurse and a general practitioner represented a good match for primary palliative care. When planning high-quality teamwork in primary care, organizational barriers to cooperation and different cultures for learning need consideration.
Highlights
Generalists such as general practitioners and district nurses have been the main actors in community palliative care in Norway
Johansen and Ervik BMC Health Services Research (2018) 18:159. How this fits in: Little is known about how general practitioners and specialised nurses cooperate in primary palliative care
To explore how rural General practitioner (GP) and oncology nurses (ONs) experience their collaboration in palliative care, we used focus group discussions (FGDs), held in 2015–2016 with health professionals involved in palliative care in rural communities of Northern Norway
Summary
Generalists such as general practitioners and district nurses have been the main actors in community palliative care in Norway. Specialised oncology nurses with postgraduate palliative training are increasingly becoming involved. This study explores how general practitioners (GPs) and oncology nurses (ONs) experience their collaboration in primary palliative care. Most palliative patients want to spend their end-of-life at home or close to home [1, 2], and many family members prefer to care for them at home [3]. In rural areas, generalists such as general practitioners (GPs) and district nurses (DNs) provide palliative home care. Studies on how well GPs deliver palliative care have found a mixed picture [9]. Palliative care offered in teams of GPs and nurses had better clinical outcomes than that provided by GPs alone. GPs wanted more training in relieving pain and other symptoms [10, 11] and some nurses wished for improvement of GPs’ skills [12]
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