title: Providing end-of-life care in general practice: findings of a national GP questionnaire survey.
abstract: BACKGROUND
  With increasing numbers of people living with complex life-limiting multimorbidity in the community, consideration must be given to improving the organisation and delivery of high-quality palliative and end-of-life care (EOLC).
  
  
  OBJECTIVE
  To provide insight into the experience of GPs providing EOLC in the community, particularly the facilitators and barriers to good-quality care.
  
  
  METHODS
  A web-based national UK questionnaire survey circulated via the Royal College of General Practitioners, NHS, Marie Curie, and Macmillan networks to GPs.
  
  
  METHODS
  Responses were analysed using descriptive statistics and an inductive thematic analysis.
  
  
  RESULTS
  Responses were received from 516 GPs, who were widely distributed in terms of practice location. Of these, 97% felt that general practice plays a key role in the delivery of care to people approaching the end of life and their families. Four interdependent themes emerged from the data: continuity of care - which can be difficult to achieve because of resource concerns including time, staff numbers, increasing primary care workload, and lack of funding; patient and family factors - with challenges including early identification of palliative care needs and recognition of the end of life, opportunity for care planning discussions, and provision of support for families; medical management - including effective symptom-control and access to specialist palliative care services; and expertise and training - the need for training and professional development was recognised to enhance knowledge, skills, and attitudes towards EOLC.
  
  
  CONCLUSIONS
  The findings reveal enduring priorities for policy, commissioning, practice development, and research in future primary palliative care.
authors.forename: Sarah
authors.initials: S
authors.lastname: Mitchell
authors.forename: Joelle
authors.initials: J
authors.lastname: Loew
authors.forename: Catherine
authors.initials: C
authors.lastname: Millington-Sanders
authors.forename: Jeremy
authors.initials: J
authors.lastname: Dale
mesh_terms: D001291:Attitude of Health Personnel; D015897:Comorbidity; D058006:General Practice / Q000592:standards; D058005:General Practitioners / Q000523:psychology*; D019538:Health Care Surveys; D006801:Humans; D010819:Physician's Role; D011788:Quality of Life; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000592:standards; D006113:United Kingdom
keywords: end-of-life care; palliative care; primary care; qualitative research; survey