Journal Article

General Practitioners’ Attitudes towards Essential Competencies in End-of-Life Care: A Cross-Sectional Survey

Zemp, Elisabeth, Elger, Bernice S., Banderet, Hans-Ruedi, Haller, Dagmar M., Jung, Corinna, Otte, Ina Carola, Gudat, Heike, Bally, Klaus, Giezendanner, Stéphanie

2017

Overview

Identifying essential competencies in end-of-life care, as well as general practitioners' (GPs) confidence in these competencies, is essential to guide training and quality improvement efforts in this domain. To determine which competencies in end-of-life care are considered important by GPs, to assess GPs' confidence in these competencies in a European context and their reasons to refer terminally ill patients to a specialist. Cross-sectional postal survey involving a stratified random sample of 2000 GPs in Switzerland in 2014. Survey development was informed by a previous qualitative exploration of relevant end-of-life GP competencies. Main outcome measures were GPs' assessment of the importance of and confidence in 18 attributes of end-of-life care competencies, and reasons for transferring care of terminally-ill patients to a specialist. GP characteristics associated with main outcome measures were tested using multivariate regression models. The response rate was 31%. Ninety-nine percent of GPs considered the recognition and treatment of pain as important, 86% felt confident about it. Few GPs felt confident in cultural (16%), spiritual (38%) and legal end-of-life competencies such as responding to patients seeking assisted suicide (35%) although more than half of the respondents regarded these competencies as important. Most frequent reasons to refer terminally ill patients to a specialist were lack of time (30%), better training of specialists (23%) and end-of-life care being incompatible with other duties (19%). In multiple regression analyses, confidence in end-of-life care was positively associated with GPs' age, practice size, home visits and palliative training. GPs considered non-somatic competencies (such as spiritual, cultural, ethical and legal aspects) nearly as important as pain and symptom control. Yet, few GPs felt confident in these non-somatic competencies. These findings should inform training and quality improvement efforts in this domain, in particular for younger, less experienced GPs.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Assisted suicide / Attitude of Health Personnel / Attitudes / Beliefs, opinions and attitudes / Biology and Life Sciences / Clinical Competence / Cross-Sectional Studies / Cultural factors / Curricula / Disease Management / Ethics / Female / General practitioners / General Practitioners - psychology / General Practitioners - standards / Health care / Health education / Hospice care / Humans / Legal medicine / Male / Management / Medical personnel / Medicine and Health Sciences / Pain / Palliative Care / Patients / People and Places / Practice / Primary care / Quality / Quality control / Questionnaires / Referral and Consultation / Regression analysis / Regression models / Research and Analysis Methods / Risk Factors / Social Sciences / Studies / Suicide / Surveys and Questionnaires / Switzerland / Terminal care / Terminal Care - ethics / Terminal Care - standards / Terminally Ill / Training