Huisarts-patiënt communicatie aan het einde van het leven: aanbevelingen op basis van de literatuur

In the Netherlands and Belgium, the general practitioner (GP) plays a central role in palliative care: on one hand he has to ensure the treatment of complaints and symptoms, on the other hand he has to foster the running process of care, by means of an optimal GP-patient communication. By means of a case history the authors give an updated overview of research articles concerning the doctor-patient communication in palliative care. Three main clusters of relevant factors for GP-patient communication are discussed: the availability of the GP for the patient, current issues that should be raised by the GP, and anticipating various scenarios. The authors offer a checklist (the ACA-checklist) allowing GPs an overview of the different factors found to be important in end-of-life communication. This checklist has to be adjusted by the general practitioner to each individual situation depending on the specific wishes and needs of the patient

Facilitators and barriers for GP–patient communication in palliative care: a qualitative study among GPs, patients, and end-of-life consultants

Background : Effective communication is considered to be essential for the delivery of high-quality care. Communication in palliative care may be particularly difficult, and there is still no accepted set of communication skills for GPs in providing palliative care. Aim : To obtain detailed information on facilitators and barriers for GP-patient communication in palliative care, with the aim to develop training programmes that enable GPs to improve their palliative care communication skills. Design of study : Qualitative study with focus groups, interviews, and questionnaires. Setting : GPs with patients receiving palliative care at home, and end-of-life consultants in the Netherlands. Method : GP (n = 20) focus groups discussing facilitators and barriers, palliative care patient (n = 6) interviews regarding facilitators, and end-of-life consultant (n = 22) questionnaires concerning barriers. Results : Facilitators reported by both GPs and patients were accessibility, taking time, commitment, and listening carefully. GPs emphasise respect, while patients want GPs to behave in a friendly way, and to take the initiative to discuss end-of-life issues. Barriers reported by both GPs and end-of-life consultants were: difficulty in dealing with former doctors' delay and strong demands from patients' relatives. GPs report difficulty in dealing with strong emotions and troublesome doctor-patient relationships, while consultants report insufficient clarification of patients' problems, promises that could not be kept, helplessness, too close involvement, and insufficient anticipation of various scenarios. Conclusion : The study findings suggest that the quality of GP-patient communication in palliative care in the Netherlands can be improved. It is recommended that specific communication training programmes for GPs should be developed and evaluated