title: Facilitators and barriers for GP-patient communication in palliative care: a qualitative study among GPs, patients, and end-of-life consultants.
abstract: BACKGROUND
  Effective communication is considered to be essential for the delivery of high-quality care. Communication in palliative care may be particularly difficult, and there is still no accepted set of communication skills for GPs in providing palliative care.
  
  
  OBJECTIVE
  To obtain detailed information on facilitators and barriers for GP-patient communication in palliative care, with the aim to develop training programmes that enable GPs to improve their palliative care communication skills.
  
  
  METHODS
  Qualitative study with focus groups, interviews, and questionnaires.
  
  
  METHODS
  GPs with patients receiving palliative care at home, and end-of-life consultants in the Netherlands.
  
  
  METHODS
  GP (n = 20) focus groups discussing facilitators and barriers, palliative care patient (n = 6) interviews regarding facilitators, and end-of-life consultant (n = 22) questionnaires concerning barriers.
  
  
  RESULTS
  Facilitators reported by both GPs and patients were accessibility, taking time, commitment, and listening carefully. GPs emphasise respect, while patients want GPs to behave in a friendly way, and to take the initiative to discuss end-of-life issues. Barriers reported by both GPs and end-of-life consultants were: difficulty in dealing with former doctors' delay and strong demands from patients' relatives. GPs report difficulty in dealing with strong emotions and troublesome doctor-patient relationships, while consultants report insufficient clarification of patients' problems, promises that could not be kept, helplessness, too close involvement, and insufficient anticipation of various scenarios.
  
  
  CONCLUSIONS
  The study findings suggest that the quality of GP-patient communication in palliative care in the Netherlands can be improved. It is recommended that specific communication training programmes for GPs should be developed and evaluated.
authors: EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands. w.slort@vumc.nl
authors: Willemjan
authors: W
authors: Slort
authors: Annette H
authors: AH
authors: Blankenstein
authors: Luc
authors: L
authors: Deliens
authors: Henriëtte E
authors: HE
authors: van der Horst
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D001293:Attitude to Death; D003142:Communication; D003253:Consultants; D006801:Humans; D008875:Middle Aged; D010166:Palliative Care / Q000523:psychology* / Q000592:standards; D010817:Physician-Patient Relations; D013727:Terminal Care / Q000523:psychology* / Q000592:standards; D055815:Young Adult