Put on the sidelines of palliative care: a qualitative study of important barriers to GPs' participation in palliative care and guideline implementation in Norway

Scand J Prim Health Care. 2024 Jun;42(2):254-265. doi: 10.1080/02813432.2024.2306241. Epub 2024 Jan 30.

Abstract

Background: Demographic changes, the evolvement of modern medicine and new treatments for severe diseases, increase the need for palliative care services. Palliative care includes all patients with life-limiting conditions, irrespective of diagnosis. In Norway, palliative care rests on a decentralised model where patient care can be delivered close to the patient's home, and the Norwegian guideline for palliative care describes a model of care resting on extensive collaboration. Previous research suggests that this guideline is not well implemented among general practitioners (GPs). In this study, we aim to investigate barriers to GPs' participation in palliative care and implementation of the guideline.

Methods: We interviewed 25 GPs in four focus groups guided by a semi-structured interview guide. The interviews were recorded and transcribed verbatim. Data were analysed qualitatively with reflexive thematic analysis.

Results: We identified four main themes as barriers to GPs' participation in palliative care and to implementation of the guideline: (1) different established local cultures and practices of palliative care, (2) discontinuity of the GP-patient relationship, (3) unclear clinical handover and information gaps and (4) a mismatch between the guideline and everyday general practice.

Conclusion: Significant structural and individual barriers to GPs' participation in palliative care exist, which hamper the implementation of the guideline. GPs should be involved as stakeholders when guidelines involving them are created. Introduction of new professionals in primary care needs to be actively managed to avoid inappropriate collaborative practices. Continuity of the GP-patient relationship must be maintained throughout severe illness and at end-of-life.

Keywords: Norway; advance care planning; clinical practice guidelines; end-of-life care, transitions of care; general practice; palliative care; palliative medicine; primary care.

Plain language summary

According to the Norwegian guideline for palliative care, the GP should have a central position in providing primary palliative care.Recent research and public reports suggest that not all GPs have such a central role or adhere to the guidelines.This study highlights individual and structural barriers that could be addressed to increase GPs’ participation in palliative care and aid the implementation of the guidelines for palliative care.

MeSH terms

  • Attitude of Health Personnel
  • General Practice*
  • General Practitioners*
  • Humans
  • Norway
  • Palliative Care
  • Qualitative Research

Grants and funding

This study was funded by the Norwegian Research Fund for General Practice, The Norwegian Committee on Research in General Practice, and The General Practice Research Unit, Norwegian University of Science and Technology. The funders had no role in data collection and analysis, selection of respondents, decision to publish, or preparation of the manuscript.