Defining effective clinician roles in end-of-life care.
OBJECTIVE
Our goal was to determine primary care clinician perceptions of what is important to the provision of quality end-of-life care.


METHODS
We used ethnography, a qualitative research method involving the use of open-ended semistructured interviews.


METHODS
We included 38 family practice residency faculty from 9 community residency programs of the Affiliated Family Practice Residency Network, Department of Family Medicine, University of Washington School of Medicine.


METHODS
The roles described by interviewees when discussing their best practices while delivering end-of-life care were compiled.


RESULTS
Primary care clinicians organize their delivery of quality end-of-life care predominantly through their relationships with patients and families. They play 3 roles when providing end-of-life care. As consultants, clinicians provide expert medical advice and treatment. As collaborators, they seek to understand the patient and family experience. Seasoned clinicians act as guides, using their personal intuitive knowledge of patient and family to facilitate everyone's growth when providing end-of-life care.


CONCLUSIONS
Shifting clinician focus from skills and knowledge toward relationship, meaning, and roles provides new opportunities to improve end-of-life care for patients, families, and clinicians.
Farber
Stuart J
SJ
Dept of Family Medicine, University of Washington School of Medicine and Tacoma Family Medicine, Tacoma, WA 98405-4272, USA. sfarber@u.washington.edu
Egnew
Thomas R
TR
Herman-Bertsch
Janet L
JL
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D005194:Family Practice; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D010819:Physician's Role; D010817:Physician-Patient Relations; D011368:Professional-Family Relations; D011787:Quality of Health Care; D012944:Social Support; D013727:Terminal Care / Q000592:standards*; D014861:Washington