Palliative and Supportive Care

Original Articles

General practitioners' experiences of the psychological aspects in the care of a dying patient

Brian Kellya1 c1, Francis T Varghesea2, Paul Burnetta3, Jane Turnera2, Marguerite Robertsona2, Patricia Kellya2, Geoffrey Mitchella4 and Pat Trestona5

a1 Centre for Rural and Remote Mental Health, University of Newcastle, Newcastle, NSW, Australia

a2 Discipline of Psychiatry, Southern Clinical School, University of Queensland Medical School, Brisbane, QLD, Australia

a3 Charles Sturt University, Wagga Wagga, NSW, Australia

a4 Discipline of General Practice, University of Queensland Medical School, Brisbane, QLD, Australia

a5 Mt. Olivet Hospital and Home Care Services, Brisbane, QLD, Australia

ABSTRACT

Objective: General practitioners (GPs) play an integral role in addressing the psychological needs of palliative care patients and their families. This qualitative study investigated psychosocial issues faced by GPs in the management of patients receiving palliative care and investigated the themes relevant to the psychosocial care of dying patients.

Method: Fifteen general practitioners whose patient had been recently referred to the Mt. Olivet Palliative Home Care Services in Brisbane participated in an individual case review discussions guided by key questions within a semistructured format. These interviews focused on the psychosocial aspects of care and management of the referred patient, including aspects of the doctor/patient relationship, experience of delivering diagnosis and prognosis, addressing the psychological concerns of the patients' family, and the doctors' personal experiences, reactions, and responses. Qualitative analysis was conducted on the transcripts of these interviews.

Results: The significant themes that emerged related to perceived barriers to exploration of emotional concerns, including spiritual issues, and the discussion of prognosis and dying, the perception of patients' responses/coping styles, and the GP's personal experience of the care (usually expressed in terms of identification with patient).

Significance of results: The findings indicate the significant challenges facing clinicians in discussions with patients and families about death, to exploring the patient's emotional responses to terminal illness and spiritual concerns for the patient and family. These qualitative date indicate important tasks in the training and clinical support for doctors providing palliative care.

(Received June 22 2007)

(Accepted August 20 2007)

Correspondence:

c1 Address correspondence and reprint requests to: Brian Kelly, Centre for Rural and Remote Mental Health, University of Newcastle, Bloomfield Hospital, Forest Rd Orange, NSW, 2800, Australia. E-mail: Brian.Kelly@newcastle.edu.au