title: How do GPs identify a need for palliative care in their patients? An interview study.
abstract: BACKGROUND
  Little is known about how GPs determine whether and when patients need palliative care. Little research has been done regarding the assumption underpinning Lynn and Adamson's model that palliative care may start early in the course of the disease. This study was conducted to explore how GPs identify a need for palliative care in patients.
  
  
  METHODS
  A qualitative interview study was performed among 20 GPs in the Netherlands.
  
  
  RESULTS
  GPs reported that a combination of several signals, often subtle and not explicit, made them identify a need for palliative care: signals from patients (increasing care dependency and not recuperating after intercurrent diseases) and signals from relatives or reports from medical specialists. GPs reported differences in how they identified a need for palliative care in cancer patients versus those with other diseases. In cancer patients, the need for palliative care was often relatively clear because of a relatively strict demarcation between the curative and palliative phase. However, in patients with e.g. COPD or in the very old, GPs' awareness of palliative care needs often arises gradually, relatively late in the disease trajectory.GPs consider the diagnosis of a life-threatening illness as a key point in the disease trajectory. However, this does not automatically mean that a patient needs palliative care at that point.
  
  
  CONCLUSIONS
  GPs recognize a need for palliative care on the basis of various signals. They do not support the idea underlying Lynn and Adamson's model that palliative care always starts early in the course of the disease.
authors.affiliation: VU University medical center (VUmc), EMGO Institute for Health and Care Research, Department of Public and Occupational Health & Expertise Center Palliative Care VUmc, Amsterdam, The Netherlands. s.claessen@vumc.nl
authors.forename: Susanne J J
authors.initials: SJ
authors.lastname: Claessen
authors.forename: Anneke L
authors.initials: AL
authors.lastname: Francke
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Engels
authors.forename: Luc
authors.initials: L
authors.lastname: Deliens
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D009426:Netherlands; D010043:Outcome and Process Assessment, Health Care; D010166:Palliative Care / Q000379:methods* / Q000592:standards; D010821:Physicians, Family / Q000523:psychology* / Q000592:standards; D010818:Practice Patterns, Physicians'; D011365:Professional Practice Location / Q000706:statistics & numerical data; D036301:Qualitative Research; D016526:Workload / Q000706:statistics & numerical data