title: General practitioners' experiences of the psychological aspects in the care of a dying patient.
abstract: OBJECTIVE
  General practitioners (GPs) play an integral role in addressing the psychological needs of palliative care patients and their families. This qualitative study investigated psychosocial issues faced by GPs in the management of patients receiving palliative care and investigated the themes relevant to the psychosocial care of dying patients.
  
  
  METHODS
  Fifteen general practitioners whose patient had been recently referred to the Mt. Olivet Palliative Home Care Services in Brisbane participated in an individual case review discussions guided by key questions within a semistructured format. These interviews focused on the psychosocial aspects of care and management of the referred patient, including aspects of the doctor/patient relationship, experience of delivering diagnosis and prognosis, addressing the psychological concerns of the patients' family, and the doctors' personal experiences, reactions, and responses. Qualitative analysis was conducted on the transcripts of these interviews.
  
  
  RESULTS
  The significant themes that emerged related to perceived barriers to exploration of emotional concerns, including spiritual issues, and the discussion of prognosis and dying, the perception of patients' responses/coping styles, and the GP's personal experience of the care (usually expressed in terms of identification with patient).
  
  
  CONCLUSIONS
  The findings indicate the significant challenges facing clinicians in discussions with patients and families about death, to exploring the patient's emotional responses to terminal illness and spiritual concerns for the patient and family. These qualitative date indicate important tasks in the training and clinical support for doctors providing palliative care.
authors.affiliation: Centre for Rural and Remote Mental Health, University of Newcastle, Newcastle, NSW, Australia. Brian.Kelly@newcastle.edu.au
authors.forename: Brian
authors.initials: B
authors.lastname: Kelly
authors.forename: Francis T
authors.initials: FT
authors.lastname: Varghese
authors.forename: Paul
authors.initials: P
authors.lastname: Burnett
authors.forename: Jane
authors.initials: J
authors.lastname: Turner
authors.forename: Marguerite
authors.initials: M
authors.lastname: Robertson
authors.forename: Patricia
authors.initials: P
authors.lastname: Kelly
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Mitchell
authors.forename: Pat
authors.initials: P
authors.lastname: Treston
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001293:Attitude to Death; D005260:Female; D017051:Hospice Care / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000523:psychology*; D010817:Physician-Patient Relations; D010821:Physicians, Family / Q000523:psychology*; D011368:Professional-Family Relations; D029181:Spirituality; D019452:Terminally Ill / Q000523:psychology*