title: Primary care physicians' educational needs and learning preferences in end of life care: A focus group study in the UK.
abstract: BACKGROUND
  Primary care physicians (General Practitioners (GPs)) play a pivotal role in providing end of life care (EoLC). However, many lack confidence in this area, and the quality of EoLC by GPs can be problematic. Evidence regarding educational needs, learning preferences and the acceptability of evaluation methods is needed to inform the development and testing of EoLC education. This study therefore aimed to explore GPs' EoLC educational needs and preferences for learning and evaluation.
  
  
  METHODS
  A qualitative focus group study was conducted with qualified GPs and GP trainees in the UK. Audio recordings were transcribed and analysed thematically. Expert review of the coding frame and dual coding of transcripts maximised rigour.
  
  
  RESULTS
  Twenty-eight GPs (10 fully qualified, 18 trainees) participated in five focus groups. Four major themes emerged: (1) why education is needed, (2) perceived educational needs, (3) learning preferences, and (4) evaluation preferences. EoLC was perceived as emotionally and clinically challenging. Educational needs included: identifying patients for palliative care; responsibilities and teamwork; out-of-hours care; having difficult conversations; symptom management; non-malignant conditions; and paediatric palliative care. Participants preferred learning through experience, working alongside specialist palliative care staff, and discussion of real cases, to didactic methods and e-learning. 360° appraisals and behavioural assessment using videoing or simulated interactions were considered problematic. Self-assessment questionnaires and patient and family outcome measures were acceptable, if used and interpreted correctly.
  
  
  CONCLUSIONS
  GPs require education and support in EoLC, particularly the management of complex clinical care and counselling. GPs value mentoring, peer-support, and experiential learning alongside EoLC specialists over formal training.
authors.affiliation: University of Bristol, School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK. lucy.selman@bristol.ac.uk.
authors.forename: Lucy Ellen
authors.initials: LE
authors.lastname: Selman
authors.affiliation: King's College London, Cicely Saunders Institute, Bessemer Road, Denmark Hill, London, SE59PJ, UK.
authors.forename: Lisa Jane
authors.initials: LJ
authors.lastname: Brighton
authors.affiliation: King's College London, Cicely Saunders Institute, Bessemer Road, Denmark Hill, London, SE59PJ, UK.
authors.forename: Vicky
authors.initials: V
authors.lastname: Robinson
authors.affiliation: King's College London, Cicely Saunders Institute, Bessemer Road, Denmark Hill, London, SE59PJ, UK.|St Christopher's Hospice, 51-59 Lawrie Park Road, London, SE26 6DZ, UK.
authors.forename: Rob
authors.initials: R
authors.lastname: George
authors.affiliation: Guy's & St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE19RT, UK.
authors.forename: Shaheen A
authors.initials: SA
authors.lastname: Khan
authors.affiliation: King's College Hospital NHS Foundation Trust, Bessemer Road, Denmark Hill, London, SE5 9RS, UK.
authors.forename: Rachel
authors.initials: R
authors.lastname: Burman
authors.affiliation: King's College London, Cicely Saunders Institute, Bessemer Road, Denmark Hill, London, SE59PJ, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Koffman
mesh_terms: D000328:Adult; D039602:After-Hours Care; D001291:Attitude of Health Personnel; D004501:Education, Medical / Q000379:methods*; D004502:Education, Medical, Continuing / Q000379:methods; D005260:Female; D017144:Focus Groups; D058005:General Practitioners / Q000193:education* / Q000523:psychology*; D006801:Humans; D007858:Learning; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D010819:Physician's Role; D012017:Referral and Consultation; D013727:Terminal Care; D006113:United Kingdom
keywords: Education; End of Life Care; General Practice; Palliative Care; Primary Health Care; Qualitative Research