title: Caring for frail older people in the last phase of life - the general practitioners' view.
abstract: BACKGROUND
  Frail older people are an increasingly important group in primary care due to demographic change. For these patients, a palliative care approach may be useful to sustain the quality of life in the last phase of their lives. While general practitioners (GPs) play a key role in the primary care for older patients, general palliative care is still in its infancy and little is known in Germany about caring for frail older people towards the end of life. This study aims to explore the tasks and challenges regarding the care for frail older patients in the last phase of life from the GPs' point of view, and the latter's perception of their own role and responsibilities.
  
  
  METHODS
  Explorative qualitative study based on semi-structured in-depth interviews with 14 GPs from urban and rural regions in Lower Saxony, Germany. Analysis was carried out according to the principles of Grounded Theory.
  
  
  RESULTS
  The GPs' key commitment "caring for frail older patients until the end" as an integral part of primary care was worked out as a key category, flanked by central issues: "causal conditions and challenges," which include patients' preconditions and care needs as well as communication and cooperation aspects on the carers' level. "Barriers and facilitators within the health system" refers to prerequisites of the German healthcare system, such as high caseloads. Regarding "strategies to comply with this commitment", various self-developed strategies for the care of frail older people are presented, depending on the GPs' understanding of their professional role and individual circumstances.
  
  
  CONCLUSIONS
  The GPs show a strong commitment to caring for the frail older patients until the end of life. However, it is a challenging and complex task that requires significant time, which can take GPs to their limits. There is a great need to improve patient-and family-centered proactive communication, as well as interprofessional cooperation. Strengthening the team approach in primary care could relieve the burden on GPs, especially in rural areas, while simultaneously improving end-of-life care for their patients.
authors.affiliation: Hannover Medical School, Institute of General Practice, Hannover, Germany.
authors.forename: Karin
authors.initials: K
authors.lastname: Geiger
authors.affiliation: Hannover Medical School, Institute of General Practice, Hannover, Germany. schneider.nils@mh-hannover.de.
authors.forename: Nils
authors.initials: N
authors.lastname: Schneider
authors.affiliation: Hannover Medical School, Institute of General Practice, Hannover, Germany.
authors.forename: Jutta
authors.initials: J
authors.lastname: Bleidorn
authors.affiliation: Hannover Medical School, Institute of General Practice, Hannover, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Klindtworth
authors.affiliation: Hannover Medical School, Institute of General Practice, Hannover, Germany.
authors.forename: Saskia
authors.initials: S
authors.lastname: Jünger
authors.affiliation: Hannover Medical School, Institute of General Practice, Hannover, Germany.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Müller-Mundt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003191:Comprehensive Health Care / Q000458:organization & administration; D005260:Female; D016330:Frail Elderly; D058005:General Practitioners / Q000523:psychology*; D005858:Germany; D006792:House Calls; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D010348:Patient Care Team / Q000458:organization & administration; D011320:Primary Health Care / Q000458:organization & administration*; D036301:Qualitative Research; D011788:Quality of Life; D013727:Terminal Care / Q000523:psychology*
keywords: End-of-life care; Frailty; General practice; Health services research; Old age; Palliative care; Primary care; Qualitative methods