title: Pediatric Oncology Palliative Care: Experiences of General Practitioners and Bereaved Parents.
abstract: OBJECTIVE
  This qualitative study set in the West Midlands region of the United Kingdom, aimed to examine the role of the general practitioner (GP) in children's oncology palliative care from the perspective of GPs who had cared for a child with cancer receiving palliative care at home and bereaved parents.
  
  
  METHODS
  One-to-one semi-structured interviews were undertaken with 18 GPs and 11 bereaved parents following the death. A grounded theory data analysis was undertaken; identifying generated themes through chronological comparative data analysis.
  
  
  RESULTS
  Similarity in GP and parent viewpoints was found, the GPs role seen as one of providing medication and support. Time pressures GPs faced influenced their level of engagement with the family during palliative and bereavement care and their ability to address their identified learning deficits. Lack of familiarity with the family, coupled with an acknowledgment that it was a rare and could be a frightening experience, also influenced their level of interaction. There was no consistency in GP practice nor evidence of practice being guided by local or national policies. Parents lack of clarity of their GPs role resulted in missed opportunities for support.
  
  
  CONCLUSIONS
  Time pressures influence GP working practices. Enhanced communication and collaboration between the GP and regional childhood cancer centre may help address identified GP challenges, such as learning deficits, and promote more time-efficient working practices through role clarity. Parents need greater awareness of their GP's wide-ranging role; one that transcends palliative care incorporating bereavement support and on-going medical care for family members.
authors.affiliation: Birmingham Children's Hospital NHS Foundation Trust, Steelhouse Lane, Birmingham, B4 6NH, UK ; School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
authors.forename: Sue J
authors.initials: SJ
authors.lastname: Neilson
authors.affiliation: Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, Faculty of Health and Social Care, London South Bank University, 103 Borough Road, SE1 0AA, London.
authors.forename: Faith
authors.initials: F
authors.lastname: Gibson
authors.affiliation: School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
authors.forename: Sheila M
authors.initials: SM
authors.lastname: Greenfield
keywords: Cancer; Children; General practitioners; Oncology; Palliative care; Qualitative