The existential dimension in general practice: identifying understandings and experiences of general practitioners in Denmark.
OBJECTIVE
The objective of this study is to identify points of agreement and disagreements among general practitioners (GPs) in Denmark concerning how the existential dimension is understood, and when and how it is integrated in the GP-patient encounter.


METHODS
A qualitative methodology with semi-structured focus group interviews was employed.


METHODS
General practice setting in Denmark.


METHODS
Thirty-one GPs from two Danish regions between 38 and 68 years of age participated in seven focus group interviews.


RESULTS
Although understood to involve broad life conditions such as present and future being and identity, connectedness to a society and to other people, the existential dimension was primarily reported integrated in connection with life-threatening diseases and death. Furthermore, integration of the existential dimension was characterized as unsystematic and intuitive. Communication about religious or spiritual questions was mostly avoided by GPs due to shyness and perceived lack of expertise. GPs also reported infrequent referrals of patients to chaplains.


CONCLUSIONS
GPs integrate issues related to the existential dimension in implicit and non-standardized ways and are hindered by cultural barriers. As a way to enhance a practice culture in which GPs pay more explicit attention to the patients' multidimensional concerns, opportunities for professional development could be offered (courses or seminars) that focus on mutual sharing of existential reflections, ideas and communication competencies. Key points Although integration of the existential dimension is recommended for patient care in general practice, little is known about GPs' understanding and integration of this dimension in the GP-patient encounter. The existential dimension is understood to involve broad and universal life conditions having no explicit reference to spiritual or religious aspects. The integration of the existential dimension is delimited to patient cases where life-threatening diseases, life crises and unexplainable patient symptoms occur. Integration of the existential dimension happens in unsystematic and intuitive ways. Cultural barriers such as shyness and lack of existential self-awareness seem to hinder GPs in communicating about issues related to the existential dimension. Educational initiatives might be needed in order to lessen barriers and enhance a more natural integration of communication about existential issues.
a Department of Public Health, Research Unit of General Practice, University of Southern Denmark , Odense C , Denmark.
Elisabeth
E
Assing Hvidt
a Department of Public Health, Research Unit of General Practice, University of Southern Denmark , Odense C , Denmark.
Jens
J
Søndergaard
b Health Services Research Unit, Lillebaelt Hospital, and Institute of Regional Health Services Research, University of Southern Denmark , Vejle , Denmark.
Jette
J
Ammentorp
c Department of Public Health , Section for General Practice, University of Copenhagen , København K , Denmark.
Lars
L
Bjerrum
a Department of Public Health, Research Unit of General Practice, University of Southern Denmark , Odense C , Denmark.
Dorte
D
Gilså Hansen
d Department of Public Health , The Research Unit for General Practice, Aarhus University , Aarhus C , Denmark.
Frede
F
Olesen
e Department of Psychology , University of Southern Denmark , Odense M Denmark.
Susanne S
SS
Pedersen
f The Danish Knowledge Centre for Rehabilitation and Palliative Care (REHPA) , National Institute of Public Health, University of Southern Denmark , København K , Denmark.
Helle
H
Timm
b Health Services Research Unit, Lillebaelt Hospital, and Institute of Regional Health Services Research, University of Southern Denmark , Vejle , Denmark.
Connie
C
Timmermann
a Department of Public Health, Research Unit of General Practice, University of Southern Denmark , Odense C , Denmark.
Niels Christian
NC
Hvidt
D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D003142:Communication; D003718:Denmark; D005086:Existentialism; D005194:Family Practice; D005260:Female; D017144:Focus Groups; D058006:General Practice; D058005:General Practitioners; D006801:Humans; D008297:Male; D008875:Middle Aged; D010819:Physician's Role; D010817:Physician-Patient Relations; D036301:Qualitative Research; D012017:Referral and Consultation; D029181:Spirituality
Denmark; GP–patient communication; General practice; existential dimension; qualitative research; spirituality