title: Caring for children dying from cancer at home: a qualitative study of the experience of primary care practitioners.
abstract: BACKGROUND
  The rarity of childhood cancers makes providing palliative care in the community an unusual event for primary care practitioners. Providing this care requires effective inter-professional collaboration with the team that forms to provide the care often working together for the first and only time.
  
  
  OBJECTIVE
  To explore the experiences of primary care practitioners following their involvement in the palliative care of a child with cancer at home.
  
  
  METHODS
  The study design was a community-based qualitative study. The study location was the West Midlands region. Purposeful sample of GPs and community nurses involved in providing palliative care to 12 children. One-to-one in-depth interviews with 47 primary care professionals (10 GPs and 37 community nurses) and 5 facilitated case discussions were undertaken. Field notes were documented and grounded theory data analysis undertaken: chronological comparative data analysis identifying generated themes.
  
  
  RESULTS
  GPs had minimal input into the preceding care of children undergoing treatment for cancer but sought to re-establish their role at the child's transition to palliative care. GPs felt they had a role to play and could add value to this phase of care, highlighted their continuing role with the child's family and acknowledged that they had gained from the experience of contributing. However, lack of specialist knowledge and uncertainty about their role within the team made this more challenging. In contrast, community nurses were routinely involved in both active treatment and palliation care phases. There was little evidence of collaboration between the specialist and primary care professionals involved. There was considerable variation in out of hours provision across cases.
  
  
  CONCLUSIONS
  Engaging primary care practitioners needs to be more actively anticipated and negotiated at the transition to palliation. Variation in out of hours care is another cause for concern. Enhancing inter-professional collaboration and planning during both active and palliative care phases may help.
authors.affiliation: Birmingham Children's Hospital NHS Foundation Trust, Steelhouse Lane, Birmingham B4 6NH, UK. s.j.neilson@bham.ac.uk
authors.forename: Sue J
authors.initials: SJ
authors.lastname: Neilson
authors.forename: Joe
authors.initials: J
authors.lastname: Kai
authors.forename: Christine
authors.initials: C
authors.lastname: Macarthur
authors.forename: Sheila M
authors.initials: SM
authors.lastname: Greenfield
mesh_terms: D000293:Adolescent; D039602:After-Hours Care; D002648:Child; D002675:Child, Preschool; D003152:Community Health Nursing; D006699:Home Care Services / Q000458:organization & administration; D006801:Humans; D007223:Infant; D007400:Interprofessional Relations; D007407:Interviews as Topic; D009369:Neoplasms / Q000451:nursing* / Q000523:psychology; D024802:Nurse's Role / Q000523:psychology; D010166:Palliative Care / Q000458:organization & administration* / Q000523:psychology; D010819:Physician's Role / Q000523:psychology; D058007:Physicians, Primary Care / Q000523:psychology*; D036301:Qualitative Research; D011795:Surveys and Questionnaires