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End-of-Life Care from the Perspective of Primary Care Providers

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ABSTRACT

PURPOSE

To explore the factors influencing primary care providers’ ability to care for their dying patients in Michigan.

METHODS

We conducted 16 focus groups to explore the provision of end-of-life care by 7 diverse primary care practices in southeast Michigan. Twenty-eight primary care providers and 22 clinical support staff participated in the study. Interviews were analyzed using thematic analysis.

RESULTS

Primary care providers (PCPs) wanted to care for their dying patients and felt largely competent to provide end-of-life care. They and their staff reported the presence of five structural factors that influenced their ability to do so: (1) continuity of care to help patients make treatment decisions and plan for the end of life; (2) scheduling flexibility and time with patients to address emergent needs, provide emotional support, and conduct meaningful end-of-life discussions; (3) information-sharing with outside providers and within the primary care practice; (4) coordination of care to address patients’ needs quickly; and (5) authority to act on behalf of their patients.

CONCLUSIONS

In order to provide end-of-life care, PCPs need structural supports within primary care for continuity of care, flexible scheduling, information-sharing, coordination of primary care, and protection of their authority.

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Acknowledgements

Dr. Silveira’s salary was supported by a US Veterans Administration Career Development Award. Research costs were supported by the Robert Wood Johnson Foundation Generalist Scholars Program. Neither the US Veterans Administration nor the Robert Wood Johnson Foundation had any role in the design of the study, collection or analysis of data, or writing of this article.

Conflict of Interest

Dr. Silveira and Dr. Forman have no conflicts of interest related to this work.

Disclaimer

The authors alone are responsible for the views, opinions, and conclusions expressed herein.

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Authors and Affiliations

  1. Veterans Administration, Health Services Research and Development Center of Excellence, 300 North Ingalls Building, Room 7C27, Box 5429, Ann Arbor, MI, USA

    Maria J. Silveira MD, MA, MPH & Jane Forman ScD, MHS

  2. Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA

    Maria J. Silveira MD, MA, MPH

Authors
  1. Maria J. Silveira MD, MA, MPH
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  2. Jane Forman ScD, MHS
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Corresponding author

Correspondence to Maria J. Silveira MD, MA, MPH.

Additional information

Prior Presentations

Preliminary results of this research were presented as abstracts at the Society of General Internal Medicine meeting in New Orleans, LA, May 2005, and the American Academy of Hospice and Palliative Medicine meeting in Nashville, TN, February 2006.

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Silveira, M.J., Forman, J. End-of-Life Care from the Perspective of Primary Care Providers. J GEN INTERN MED 27, 1287–1293 (2012). https://doi.org/10.1007/s11606-012-2088-3

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  • DOI: https://doi.org/10.1007/s11606-012-2088-3

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