General practitioners and general practitioner registrars' experiences and learning from caring for dying patients: a scoping review.

Abstract

The general practitioners' (GP) workforce is in crisis, with 22% of GPs feeling so stressed by the pressures of general practice they cannot cope. Patient death is the greatest stressor in medical practice and has an impact on the personal stress and well-being of doctors. Providing good holistic care for dying patients in the community keeps patients in their preferred place of care and reduces unnecessary costly interventions and hospital admissions. It is crucial to explore the experiences and learning of GP and general practitioner registrars' (GPR)-who represent the future primary care workforce-in caring for dying patients. We aimed to understand what is known about GPs and GPR experiences of, and learning from, caring for dying patients to outline current knowledge and identify future research options. We included all studies that explored GP and GPR experiences and learning related to adult dying, palliative, terminal care and death. Four electronic databases (MEDLINE, EMBASE, PsycINFO and Cochrane) as well as reference lists and hand-searching key journals were searched from January 2003 until February 2025. Data were extracted and charted by all authors and then a qualitative content approach was used to analyse and interpret the data. The database search yielded 3378 publications; 17 studies have been included in the scoping review. This includes over 4412 participants, mostly GPs/GPRs. GPs/GPRs gain knowledge, skills and confidence when they have exposure and hands-on experience with dying patients. Uncertainty, intolerance of ambiguity, fear of initiating conversations around dying and perceived lack of knowledge were barriers for caring for dying patients. Facilitators such as safe learning environments with ongoing support from supervisors and protected time to discuss, debrief and reflect were valuable. Timely understanding of the current structural, practice level factors such as learning and emotional issues and challenges is required to upskill and support doctors, which can lead to improved emotional well-being and workforce retention-all of which will directly benefit dying patients and relatives at this significant part of their lives.