Factors influencing palliative care. Qualitative study of family physicians' practices.
OBJECTIVE
To examine factors that influence family physicians' decisions to practise palliative care.


METHODS
Qualitative method of in-depth interviews.


METHODS
Southwestern Ontario.


METHODS
Family physicians who practise palliative care on a full-time basis, who practise on a part-time basis, or who have retired from active involvement in palliative care.


METHODS
Eleven in-depth interviews were conducted to explore factors that influence family physicians' decisions to practise palliative care and factors that sustain their interest in palliative care. All interviews were audiotaped and transcribed verbatim. The analysis strategy used a phenomenological approach and occurred concurrently rather than sequentially. All interview transcriptions were read independently by the researchers, who then compared and combined their analyses. Final analysis involved examining all interviews collectively, thus permitting relationships between and among central themes to emerge.


RESULTS
The overriding theme was a common philosophy of palliative care focusing on acceptance of death, whole person care, compassion, communication, and teamwork. Participants' philosophies were shaped by their education and by professional and personal experiences. In addition, participants articulated personal and systemic factors currently affecting their practice of palliative care.


CONCLUSIONS
Participants observed that primary care physicians should be responsible for their patients' palliative care within the context of interdisciplinary teams. For medical students to be knowledgeable and sensitive to the needs of dying patients, palliative care should be given higher priority in the curriculum. Finally, participants argued compellingly for transferring the philosophy of palliative care to the overall practice of medicine.
Brown
J B
JB
Centre for Studies in Family Medicine, University of Western Ontario, London. jbbrown@julian.uwo.ca
Sangster
M
M
Swift
J
J
D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D003657:Decision Making; D005194:Family Practice / Q000193:education; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario; D010166:Palliative Care; D010686:Philosophy, Medical; D010818:Practice Patterns, Physicians'