General practitioners' perspective on timely interprofessional case conferences on non-cancer patients with palliative care needs: a qualitative study (KOPAL).

Abstract

Patients with progressive chronic non-malignant diseases (CNMD) such as chronic obstructive pulmonary disease, congestive heart failure and dementia could benefit from specialist palliative home care (SPHC). The two-arm, cluster randomised controlled KOPAL trial was conducted to test the effectiveness of a timely SPHC nurse-patient consultation followed by an interprofessional telephone case conference between general practitioners and SPHC teams. This study was a component of the KOPAL trial and aims to explore general practitioners' (GP) experiences with treating CNMD patients before and with case conferences and with the following consequences for treatment and interprofessional collaboration with SPHC teams. Qualitative evaluation of the KOPAL trial focussing on GPs' perspective. Open guided interviews using narrative techniques analysed with grounded theory. The KOPAL trial was conducted in Lower Saxony and the metropolitan region of Hamburg, Germany. 24 GPs who participated in the intervention group of the trial were interviewed. Findings show that GPs have practice-specific routines when caring for people with CNMD. Interprofessional case conferences may lead to more awareness regarding gaps in primary palliative care, one's own care routines or a lack of psychosocial support. Although gaining new insights, GPs follow three different strategies following the case conferences: (1) Maintain routines of care and disregard added value, (2) extend routines of care according to SPHC advice and (3) integration and partial change of care routines caused by SPHC support. These strategies are influenced by GPs' perception of SPHC teams (eg, ambivalence towards SPHC). Interprofessional case conferences to timely discuss care options could improve healthcare for patients with advanced CNMD by revealing gaps in care. Promoting a regular process of exchange between GPs and SPHC teams (such as through round tables) may improve a trusting cooperation. DRKSS00017795.