title: Heartsink encounters: a qualitative study of end-of-life care in out-of-hours general practice.
abstract: OBJECTIVE
  We aimed to establish how prepared GPs who work regular out-of-hours shifts feel when dealing with end-of-life issues in palliative care patients, what they thought about seeing such patients and whether they considered themselves emotionally equipped to do so.
  
  
  METHODS
  Semi-structured interviews were conducted with GPs who worked regular out-of-hours shifts. A detailed analysis of transcripts using Interpretative Phenomenological Analysis was undertaken.
  
  
  METHODS
  South Wales.
  
  
  METHODS
  GPs employed by the local health board's out-of-hours service were contacted.
  
  
  METHODS
  All interview data were analysed systematically and statements that reflected emotional impact and strain were highlighted, coded and interpreted within their context.
  
  
  RESULTS
  GPs expressed unease and used terms such as 'heartsink', when having to deal with palliative care issues out-of-hours. Heartsink in this context referred to the subjective experience of the clinician. Emotional 'housekeeping', i.e. looking after oneself after emotionally-charged encounters, was felt to be a very important process and GPs used a range of coping mechanisms, including reflective time, sharing with peers, compartmentalisation and personal empathy to deal with stress.
  
  
  CONCLUSIONS
  The emotional effects of palliative care encounters on out-of-hours GPs should not be underestimated. Our interpretation distinguished the term 'heartsink' from its usual context, the 'heartsink patient', to a different meaning, that of the imminent palliative care encounter triggering a sensation of heartsink for some out-of-hours doctors. Therefore, the term 'heartsink encounter', rather than heartsink patient, seemed more fitting. Pressed services may encourage a culture where discussion or debrief with a colleague after a palliative care encounter is not perceived as a practical option. This may contribute to work-related burnout in this group of doctors and out-of-hours collaboratives need to be aware of this issue, when planning their services.
authors.affiliation: Marie Curie Centre Penarth and Palliative Care Department, Cardiff University, Velindre Hospital ,  Cardiff CF14 2TL ,  UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Taubert
authors.forename: Annmarie
authors.initials: A
authors.lastname: Nelson