title: End-of-life care from the perspective of primary care providers.
abstract: OBJECTIVE
  To explore the factors influencing primary care providers' ability to care for their dying patients in Michigan.
  
  
  METHODS
  We conducted 16 focus groups to explore the provision of end-of-life care by 7 diverse primary care practices in southeast Michigan. Twenty-eight primary care providers and 22 clinical support staff participated in the study. Interviews were analyzed using thematic analysis.
  
  
  RESULTS
  Primary care providers (PCPs) wanted to care for their dying patients and felt largely competent to provide end-of-life care. They and their staff reported the presence of five structural factors that influenced their ability to do so: (1) continuity of care to help patients make treatment decisions and plan for the end of life; (2) scheduling flexibility and time with patients to address emergent needs, provide emotional support, and conduct meaningful end-of-life discussions; (3) information-sharing with outside providers and within the primary care practice; (4) coordination of care to address patients' needs quickly; and (5) authority to act on behalf of their patients.
  
  
  CONCLUSIONS
  In order to provide end-of-life care, PCPs need structural supports within primary care for continuity of care, flexible scheduling, information-sharing, coordination of primary care, and protection of their authority.
authors.affiliation: Veterans Administration, Health Services Research and Development Center of Excellence, 300 North Ingalls Building, Room 7C27, Box 5429, Ann Arbor, MI USA. mariajs@umich.edu
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Silveira
authors.forename: Jane
authors.initials: J
authors.lastname: Forman
mesh_terms: D001291:Attitude of Health Personnel; D003266:Continuity of Patient Care / Q000639:trends; D006282:Health Personnel / Q000523:psychology* / Q000639:trends; D006801:Humans; D058007:Physicians, Primary Care / Q000523:psychology / Q000639:trends; D011320:Primary Health Care / Q000379:methods* / Q000639:trends; D013727:Terminal Care / Q000379:methods* / Q000523:psychology*