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

• Published in: PloS one 2017-02, Vol.12 (2), p.e0170168-e0170168
• Main Authors: Giezendanner, Stéphanie, Jung, Corinna, Banderet, Hans-Ruedi, Otte, Ina Carola, Gudat, Heike, Haller, Dagmar M, Elger, Bernice S, Zemp, Elisabeth, Bally, Klaus
• Format: Article
• Language: English
• Subjects: 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
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0170168

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.