title: Home-Based Palliative Care for Children With Incurable Cancer: Long-term Perspectives of and Impact on General Practitioners.
abstract: Although a large percentage of children with advanced-stage cancer die at home, remarkably little information is available regarding the experience of general practitioners (GPs) with respect to providing home-based palliative care to children with incurable cancer.
  
  
  
  The objective of this study was to explore the perspectives of GPs who care for children with advanced-stage cancer in a home-based setting.
  
  
  
  In this cross-sectional study, 144 GPs who provided home-based palliative care to 150 children with incurable cancer from 2001 through 2010 were invited to complete a questionnaire addressing their perspectives regarding: 1) symptom management, 2) collaboration with other health care professionals, 3) the child's death and care after death, and 4) impact of having provided palliative care, scored on distress thermometer (range 0-10).
  
  
  
  A total of 112 GPs (78%) responded, and 91 GPs completed the questionnaire for 93 patients. The median interval between the child's death and completing the questionnaire was seven years. The most prevalent symptoms reported in the patients were fatigue (67%) and pain (61%). Difficulties with communicating with (14%), coordinating with (11%), collaborating with (11%), and contacting (2%) fellow members of the multidisciplinary treatment team were rare. Hectic (7%) and shocking (5%) situations and panic (2%) around the child's death were rare. GPs reported feelings of sadness (61%) and/or powerlessness (43%) around the time of the patient's death, and they rated their own distress level as relatively high during the terminal phase (median score 6, range 0-9.5). The majority of GPs (94%) reported that they ultimately came to terms with the child's death.
  
  
  
  In general, GPs appear to be satisfied with the quality of home-based palliative care that they provide pediatric patients with incurable cancer. Communication among health care professionals is generally positive and is considered important. Finally, although the death of a pediatric patient has a profound impact on the GP, the majority of GPs eventually come to terms with the child's death.
authors.affiliation: Department of Pediatric Oncology and Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands; Princess Màxima Center for Pediatric Oncology, Utrecht, The Netherlands. Electronic address: i.vandergeest@erasmusmc.nl.
authors.forename: Ivana M M
authors.initials: IM
authors.lastname: van der Geest
authors.affiliation: Department of General Practice, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Patrick J E
authors.initials: PJ
authors.lastname: Bindels
authors.affiliation: Department of Pediatric Oncology and Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands; Princess Màxima Center for Pediatric Oncology, Utrecht, The Netherlands.
authors.forename: Saskia M F
authors.initials: SM
authors.lastname: Pluijm
authors.affiliation: Department of Pediatric Oncology and Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Erna M C
authors.initials: EM
authors.lastname: Michiels
authors.affiliation: Department of Public Health, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Agnes
authors.initials: A
authors.lastname: van der Heide
authors.affiliation: Princess Màxima Center for Pediatric Oncology, Utrecht, The Netherlands.
authors.forename: Rob
authors.initials: R
authors.lastname: Pieters
authors.affiliation: Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom.
authors.forename: Anne-Sophie E
authors.initials: AE
authors.lastname: Darlington
authors.affiliation: Princess Màxima Center for Pediatric Oncology, Utrecht, The Netherlands.
authors.forename: Marry M
authors.initials: MM
authors.lastname: van den Heuvel-Eibrink
mesh_terms: D000328:Adult; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D002648:Child; D003430:Cross-Sectional Studies; D019468:Disease Management; D005260:Female; D058005:General Practitioners / Q000523:psychology*; D006699:Home Care Services; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D010166:Palliative Care; D011795:Surveys and Questionnaires; D013727:Terminal Care
chemical_list: D000700:Analgesics
keywords: Cancer; children; general practice; palliative care