General Practitioners' Attitudes towards Essential Competencies in End-of-Life Care: A Cross-Sectional Survey.
BACKGROUND
Identifying essential competencies in end-of-life care, as well as general practitioners' (GPs) confidence in these competencies, is essential to guide training and quality improvement efforts in this domain.


OBJECTIVE
To determine which competencies in end-of-life care are considered important by GPs, to assess GPs' confidence in these competencies in a European context and their reasons to refer terminally ill patients to a specialist.


METHODS
Cross-sectional postal survey involving a stratified random sample of 2000 GPs in Switzerland in 2014.


METHODS
Survey development was informed by a previous qualitative exploration of relevant end-of-life GP competencies. Main outcome measures were GPs' assessment of the importance of and confidence in 18 attributes of end-of-life care competencies, and reasons for transferring care of terminally-ill patients to a specialist. GP characteristics associated with main outcome measures were tested using multivariate regression models.


RESULTS
The response rate was 31%. Ninety-nine percent of GPs considered the recognition and treatment of pain as important, 86% felt confident about it. Few GPs felt confident in cultural (16%), spiritual (38%) and legal end-of-life competencies such as responding to patients seeking assisted suicide (35%) although more than half of the respondents regarded these competencies as important. Most frequent reasons to refer terminally ill patients to a specialist were lack of time (30%), better training of specialists (23%) and end-of-life care being incompatible with other duties (19%). In multiple regression analyses, confidence in end-of-life care was positively associated with GPs' age, practice size, home visits and palliative training.


CONCLUSIONS
GPs considered non-somatic competencies (such as spiritual, cultural, ethical and legal aspects) nearly as important as pain and symptom control. Yet, few GPs felt confident in these non-somatic competencies. These findings should inform training and quality improvement efforts in this domain, in particular for younger, less experienced GPs.
Centre for Primary Health Care, University of Basel, Basel, Switzerland.
Stéphanie
S
Giezendanner
Centre for Primary Health Care, University of Basel, Basel, Switzerland.
Corinna
C
Jung
Centre for Primary Health Care, University of Basel, Basel, Switzerland.
Hans-Ruedi
HR
Banderet
Institute for Biomedical Ethics, University of Basel, Basel, Switzerland.
Ina Carola
IC
Otte
Hospiz im Park, Hospital for Palliative Care, Arlesheim, Basel District, Switzerland.
Heike
H
Gudat
Primary Care Unit, University of Geneva, Geneva, Switzerland.|Department of General Practice, the University of Melbourne, Melbourne, Victoria, Australia.
Dagmar M
DM
Haller
Institute for Biomedical Ethics, University of Basel, Basel, Switzerland.|Center of Legal Medicine, University of Geneva, Geneva, Switzerland.
Bernice S
BS
Elger
Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland.|University of Basel, Basel, Switzerland.
Elisabeth
E
Zemp
Centre for Primary Health Care, University of Basel, Basel, Switzerland.
Klaus
K
Bally
D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D019468:Disease Management; D005260:Female; D058005:General Practitioners / Q000523:psychology* / Q000592:standards*; D006801:Humans; D008297:Male; D010166:Palliative Care; D012017:Referral and Consultation; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013557:Switzerland; D013727:Terminal Care / Q000941:ethics / Q000592:standards; D019452:Terminally Ill