End-of-Life Care from the Perspective of Primary Care Providers
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To explore the factors influencing primary care providers’ ability to care for their dying patients in Michigan.
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.
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.
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.
KEY WORDSprimary care practice palliative care end of life qualitative
- 1.Starfield B. Primary Care: concept, evaluation, and policy. New York: Oxford University Press; 1992.Google Scholar
- 2.National Center for Health Statistics. Deaths by place of death, age, race, and sex: United States, 1999–2005. 2005; http://www.cdc.gov/nchs/nvss/mortality/gmwk309.htm. Accessed March 16, 2012.
- 3.Macguire P. Use of mandatory hospitalists blasted; ACP others protest plans that force doctors to give up inpatient care. ACP Internist: ASP-ASIM; 1999.Google Scholar
- 4.Brown RG. Hospitalist concept: another dangerous trend. Am Fam Physician. 1998.Google Scholar
- 5.Lo B. Ethical and policy implications of hospitalist systems. Am J Med. 2001;111(9B):48–52.Google Scholar
- 7.Hanson LC, Danis M, Garrett J. What is wrong with end-of-life care? Opinions of bereaved family members. JAGS. 1997;45(11):1339–1344.Google Scholar
- 10.Palmer TA, Galanos AN, Hays JC. Preference for place of death among healthy elderly. JAGS. 1999;47(9):S50.Google Scholar
- 13.Sisler JJ, Brown JB, Stewart M. Family physicians' roles in cancer care. Survey of patients on a provincial cancer registry. Can Fam Physician. 2004;50(6):889–896.Google Scholar
- 18.End of life care strategy: promoting high quality care for all adults at the end of life. London: National Health Service;2008.Google Scholar
- 20.Duncan DE. Life at All Costs: Part One, The Mid-Death Crisis. The Fiscal Times. March 9, 2010; Life & Money.Google Scholar
- 22.United States Congress, House of Representatives. Compilation of Patient Protection and Affordable Care Act: as amended through November 1, 2010 including Patient Protection and Affordable Care Act health-related portions of the Health Care and Education Reconciliation Act of 2010. Washington: US Government Printing Office; 2010.Google Scholar
- 23.Patient-centered Primary Care Collaborative. Joint principles of patient centered medical home. 2007; http://www.pcpcc.net/joint-principles. Accessed March 16, 2012.
- 24.Assurance NCQF. Patient centered medical home. 2012; http://www.ncqa.org/tabid/631/default.aspx. Accessed March 16, 2012.
- 25.AHRQ. Patient Centered Medical Home: Resource Center. 2012; http://www.pcmh.ahrq.gov/portal/server.pt/community/pcmh_home/1483. Accessed March 16, 2012.
- 26.Veterans Administration. Patient-Centered Medical Home Concept Paper. 2011; www.va.gov/PrimaryCare/docs/pcmh_ConceptPaper.doc. Accessed March 16, 2012.
- 27.Han P, Rayson D. The coordination of primary and oncology specialty care at the end of life. JNCI. 2011;40:31–37.Google Scholar
- 28.Patton MQ. Qualitative Research and Evaluation Methods. Thousand Oaks, CA: Sage; 2002.Google Scholar
- 30.Sobo EJ. Culture and Meaning in Health Services Research: a practical field guide. Walnut Creek, CA.: Left Coast Press; 2009.Google Scholar
- 32.Miles MB, Huberman M. Focusing and bounding the collection of data: the substantive start. Qualitatvie Data Analysis, 2nd edition. Thousand Oaks, CA: Sage; 1994.Google Scholar
- 37.Forrest CB, Glade GB, Baker AE, Bocian A, von Schrader S, Starfield B. Coordination of specialty referrals and physician satisfaction with referral care. Arch Pediatr Adolesc Med. 2000;154(5):499–506.Google Scholar
- 38.Gandhi TK, Sittig DF, Franklin M, al. E. Communication breakdown in the outpatient referral process. J Gen Intern Med. 2000;15(9):626–631.Google Scholar
- 41.Nutting PA, Crabtree BF, Miller WL, et al. Journey to the patient-centered medical home: a qualitative analysis of the experiences of practices in the National Demonstration Project. Ann Fam Med. 2010;8 Suppl 1:S45-56; S92.Google Scholar