[Ambulant care of patients in the terminal phase of malignant tumor: answers by general practioners in Thuringia to a questionnaire].
OBJECTIVE
Palliative care and care of the dying are not widely taught in medical education. Yet, through the guidelines of the Federal Medical Council (Bundesärztekammer), doctors are obliged professionally to accompany the dying process. Systematic studies concerning doctors' motivation and action in this special situation are rare. This study aims to evaluate the views and attitudes of general practitioners towards the care for cancer patients in the terminal stage of disease.


METHODS
In association with the project of the German Ministry of Health "Patienten als Partner-Tumorpatienten und ihr Mitwirken in medizinischen Entscheidungen" ("Patients as partners: patients with malignant tumor and their collaboration in medical decision making"), a questionnaire was designed for general practitioners based on qualitative interviews. The self-guiding questionnaire comprised questions concerning death and dying, patient-doctor relationship and day-to-day medical actions.


RESULTS
505 general practitioners (GPs) received the questionnaires. 170 were filled in and sent back (33%). The GPs felt responsible for the care of the dying patients. Pain control was the main goal (97%). Symptom control was thought to be important/very important in 87%, the application of life-prolonging measures in 12 %. Basic analgesic medication was prescribed by 93% of GPs. 89%/77% of the general practitioners answered that they were satisfied with the technical equipment of the hospital/clinic, whereas there was a dissatisfaction with psychological and spiritual support.


CONCLUSIONS
General practitioners widely accept their responsibility for the care of the dying patients. Pain control is the major goal in this group of patients. Some items (use of co-analgesia, prescription of peak analgesia) seem to be open to improvements. Despite a high motivation, general practitioners show their dissatisfaction with some aspects of the care for dying people. Palliative care teams could be helpful in this situation.
Modellprojekt Patienten als Partner-Tumorpatienten und ihr Mitwirken bei medizinischen Entscheidungen 1, Friedrich-Schiller-Universität Jena. Birgitt.Oorschot@uni-jena.de
B
B
van Oorschot
S
S
Schweitzer
D000553:Ambulatory Care; D000700:Analgesics / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D001293:Attitude to Death; D003627:Data Interpretation, Statistical; D005194:Family Practice; D005260:Female; D005858:Germany; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000503:physiopathology / Q000628:therapy*; D010146:Pain / Q000188:drug therapy / Q000209:etiology; D010817:Physician-Patient Relations; D011795:Surveys and Questionnaires; D013727:Terminal Care
D000700:Analgesics