GPs' motives and perceived responsibilities for discussing the values, wishes and needs of patients with advanced cancer.

Abstract

Exploring and monitoring the values, wishes, and needs (VWN) of patients with advanced cancer is crucial for guiding appropriate care in the palliative phase. To gain insight into how general practitioners (GPs) perceive their responsibilities and underlying motives in exploring and monitoring the VWN of patients with advanced cancer in the palliative phase. This qualitative study involved GPs with experience in adult palliative care, purposively recruited in the Netherlands. Guided by an interpretivist-constructivist approach, data were collected through semi-structured interviews and analyzed using reflexive thematic analysis. Twenty GPs participated, aged 38-62, with 7-28 years' experience. Participants were driven to discuss patients' VWN by the central motive: to support patients in achieving a peaceful death. This motive is underpinned by three interrelated responsibilities as perceived by participants: 1) managing physical symptoms and treatment decisions, 2) guiding and preparing patients for the end of life, and 3) ensuring optimal collaboration. Participants described gauging patients' readiness by introducing topics and observing responses. While they emphasized that discussions about VWN should not follow a checklist, several found them abstract and questioned whether socio-existential concerns received enough attention. GPs discuss VWN primarily to support a peaceful death. This may facilitate attention to end-of-life decision-making but may also narrow communication, with less attention to patients' multidimensional symptoms and concerns while living with advanced illness. Training in communication and cultural competence can broaden this focus to support patients in living well until the end of life.