The Role of Primary Care Physicians in Providing End-of-Life Care

2018 ◽  
Vol 36 (3) ◽  
pp. 249-254 ◽  
Author(s):  
Jan Tse Liu ◽  
Iris Kovar-Gough ◽  
Nabila Farabi ◽  
Frank Animikwam ◽  
Sarah Beth Weers ◽  
...  
Keyword(s):  
Primary Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Primary Care Physicians ◽  
The United States ◽  
Narrative Review ◽  
Cochrane Library ◽  
Life Care ◽  
Number Of Patients ◽  
Wide Range

Background: Primary care physicians (PCPs) frequently have long-term relationships with patients as well as their families. As such they are well positioned to care for their patients at the end of their lives. As the number of patients in need of end-of-life care continues to grow, it is critical to understand how PCPs can fulfill that need. The purpose of our study is to perform a narrative review of the literature and develop a theoretical model delineating the overarching roles played by PCPs in caring for patients at the end of life. Methods: For this narrative review, the authors searched Medline (PubMed), Embase, Cochrane Library, and Scopus up to March 22, 2017. Articles were not limited by geography. Results: Review of existing literature generally supports 4 broad categories as the primary roles for PCP involvement in end of life: pain and symptom management; information management, including transmitting and clarifying information, setting care priorities, and assisting patients with treatment decisions; coordinating care and collaborating with other providers; and addressing patients’ social, emotional, and spiritual needs. Conclusions: Based on the results of this review, PCPs provide a wide range of services to patients at the end of life. Promoting the provision of the full scope of services by PCPs will help ensure improved continuity of care while providing the highest quality of care for patients, both in the United States and around the world.

scholarly journals Primary care physicians’ educational needs and learning preferences in end of life care: A focus group study in the UK

2017 ◽  
Vol 16 (1) ◽  
Author(s):  
Lucy Ellen Selman ◽  
Lisa Jane Brighton ◽  
Vicky Robinson ◽  
Rob George ◽  
Shaheen A. Khan ◽  
...  
Keyword(s):  
Primary Care ◽  
Focus Group ◽  
End Of Life ◽  
End Of Life Care ◽  
Primary Care Physicians ◽  
Educational Needs ◽  
Learning Preferences ◽  
Life Care ◽  
Focus Group Study ◽  
The Uk

Physician perspectives on end-of-life care: Factors of race, specialty, and geography

2006 ◽  
Vol 4 (3) ◽  
pp. 257-271 ◽  
Author(s):  
CINDY L. CARTER ◽  
JANE G. ZAPKA ◽  
SUZANNE O'NEILL ◽  
SUSAN DesHARNAIS ◽  
WINNIE HENNESSY ◽  
...  
Keyword(s):  
Primary Care ◽  
African American ◽  
End Of Life ◽  
Racial Differences ◽  
End Of Life Care ◽  
Urban Areas ◽  
Primary Care Physicians ◽  
Working Relationships ◽  
Life Care ◽  
Physician Perspectives

Objectives: To describe physicians' end-of-life practices, perceptions regarding end-of-life care and characterize differences based upon physician specialty and demographic characteristics. To illuminate physicians' perceptions about differences among their African-American and Caucasian patients' preferences for end-of-life care.Design and methods: Twenty-four African-American and 16 Caucasian physicians (N= 40) participated in an in-person interview including 23 primary care physicians, 7 cardiologists, and 10 oncologists. Twenty-four practices were in urban areas and 16 were in rural counties.Results: Physicians perceived racial differences in preferences for end-of-life care between their Caucasian and African-American patients. Whereas oncologists and primary care physicians overwhelmingly reported having working relationships with hospice, only 57% of cardiologists reported having those contacts. African-American physicians were more likely than Caucasian physicians to perceive racial differences in their patients preferences for pain medication.Significance of results: Demographic factors such as race of physician and patient may impact the provider's perspective on end-of-life care including processes of care and communication with patients.

US, Russian and Indian physician perspectives regarding end of life care

2020 ◽  
Vol 24 (3) ◽  
pp. 11-20
Author(s):  
James G. Jackson ◽  
Sheetal Moolambally Raj ◽  
Yulia Matveeva ◽  
Yinghui Xu ◽  
Gerald J. Jogerst
Keyword(s):  
Primary Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Primary Care Physicians ◽  
Terminal Illness ◽  
Life Care ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Chi Squared ◽  
Dichotomous Variables

Aim. To compare US, Russian and Indian primary care physicians attitudes, comfort and experiences providing palliative care. Design. Cross sectional survey. Settings. Iowa, USA; Leningrad Oblast, Russia; Mangalore, India. Participants. Primary care physicians. Methods. Chi-squared testing for dichotomous variables and t-tests for mean scores. Results. 66 US, 81 Russian and 95 Indian physicians completed the survey. More US physicians preferred end of life care at home (83% v 56% Russian and 29% Indian) p 0.001 and Indian physicians preferring hospitals (36% v 0% US and 1% Russian) p 0.001. 94% percent of US physicians preferred patient make their own decisions, 57% of Russian sample preferred physicians as decision makers, and Indian physicians preferred family members to patients themselves (44%) p 0.001. Patient should be informed (US vs Russia vs India) of terminal illness Always (74% vs 31% vs 33%) p 0.001, If Asked (9% vs 64% vs 12%) p 0.001 or Physicians Judgement (15%, 5%, 54%) p 0.001. US physicians reported higher comfort rates with managing symptoms at the end of life. In the last 6 months US physicians were more satisfied with provided care Often or Always (63% vs 36% Russian v 21% Indian) p 0.001. Conclusions. US sample was more concerned with patient autonomy and had more comfort and satisfaction in providing end of life care compared to Russian and Indian samples.

Fatigue and lethargy in palliative care

2020 ◽  
Vol 13 (5) ◽  
pp. 268-272
Author(s):  
Amarjodh Landa
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Ageing Population ◽  
Life Care ◽  
Wide Range ◽  
Significant Symptom

Fatigue is a particularly vague, yet significant symptom, which is commonly encountered in primary care. It affects a wide range of patients and has many causes. With an ageing population, fatigue is more likely to be multifactorial towards the end of a person’s life, and this can provide challenges in recognition and management. Patients are often incapacitated due to their fatigue and helping to manage it can lead to an improved quality of life. This article aims to briefly summarise the symptoms of fatigue, how to recognise it and the various causes. Current literature on the management of fatigue in end-of-life care, including pharmacological options, is critically reviewed.

Electronic cigarettes: How confident and effective are allergists, pulmonologists, and primary care physicians in their practice behavior?

2020 ◽  
Vol 41 (3) ◽  
pp. 192-197
Author(s):  
Sherry S. Zhou ◽  
Alan P. Baptist
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Electronic Cigarettes ◽  
The United States ◽  
Fisher Exact Test ◽  
Exact Test ◽  
Knowledge And Beliefs ◽  
Tobacco Cigarette ◽  
Number Of Patients ◽  
Personal Use

Background: There has been a striking increase in electronic cigarette (EC) use in the United States. The beliefs and practices toward ECs among physicians are unknown. Objective: The purpose of this study was to investigate EC practice patterns among allergists, pulmonologists, and primary care physicians. Methods: An anonymous survey was sent to physicians. The survey contained 32 questions and addressed issues related to demographics, cessation counseling behaviors, personal use, and knowledge and beliefs about ECs. Statistical analysis was performed by using analysis of variance, the Pearson χ2 test, Fisher exact test, and logistic regression. Results: A total of 291 physicians completed the survey (222 primary care physicians, 33 pulmonologists, and 36 allergists) for a response rate of 46%. The allergists asked about tobacco cigarette use as frequently as did the pulmonologists and more than the primary care physicians (p < 0.001), but they rarely asked about EC use. The pulmonologists scored highest on self-reported knowledge on ECs, although all the groups answered <40% of the questions correctly. The allergists did not feel as comfortable about providing EC cessation counseling as did the pulmonologists and primary care physicians (p < 0.001). All three groups were equally unlikely to recommend ECs as a cessation tool for tobacco cigarette users. Conclusion: Allergists lacked knowledge and confidence in providing education and cessation counseling for EC users. As the number of patients who use these products continues to increase, there is an urgent need for all physicians to be comfortable and knowledgeable with counseling about ECs.

scholarly journals Last Place of Care and End-of-Life Quality of Life in the United States: Evidence From a National Representative Data Set

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 17-17
Author(s):  
Yifan Lou ◽  
Nan Jiang ◽  
Katherine Ornstein
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
End Of Life ◽  
End Of Life Care ◽  
The United States ◽  
Life Care ◽  
Person Centered Care ◽  
Centered Care ◽  
The Relationship

Abstract Background: Quality of life (QoL) during last stage of life has raised expanded interests as an important aspect of person-centered care. Last place of care (LPC), refer to the last place decedents received their formal end-of-life care (EOLC), has been identified as a key indicator of older adults’ end-of-life QoL, but the relationship was understudied. This study explores the association between LPC and end-of-life QoL among American older adults. Methods: Data used seven waves of Last Month of Life data with a total sample of 3068 Medicare decedents in NHATS. Outcome is end-of-life QoL assessed by eleven measures on four domains: pain and symptoms management (SP), quality of healthcare encounter (HE), person-centered care (PC), and overall quality of care (QC). LPC was categorized into home, hospital, nursing home, and residential hospice. Multivariate logistic regression analyses were used to examine the relationship with covariates. Results: LPC varied by most demographic characteristics, except immigration status and education. Older adults whose LPC is hospital, compared to those who had home-care, were less likely to have great experiences on HE, PC, and QC. People dying at nursing homes are more likely to receive care meeting their dyspnea and spiritual needs. Residential hospice is negatively related to respected care, clear coordination, and keeping family informed, but are more likely to provide PS and spiritual care. Discussion: Home-based end-of-life care has certain advantages but still has room to improve on SP and religious concerns. Hospitals should keep reforming their service delivery structure to improve patients’ QoL.

How individual ethical frameworks shape physician trainees’ experiences providing end-of-life care: a qualitative study

2021 ◽  
pp. medethics-2020-106690
Author(s):  
Sarah Rosenwohl-Mack ◽  
Daniel Dohan ◽  
Thea Matthews ◽  
Jason Neil Batten ◽  
Elizabeth Dzeng
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Shared Decision Making ◽  
End Of Life Care ◽  
The United States ◽  
Ethical Framework ◽  
Shared Decision ◽  
Life Care ◽  
Best Interest ◽  
Ethical Frameworks

ObjectivesThe end of life is an ethically challenging time requiring complex decision-making. This study describes ethical frameworks among physician trainees, explores how these frameworks manifest and relates these frameworks to experiences delivering end-of-life care.DesignWe conducted semistructured in-depth exploratory qualitative interviews with physician trainees about experiences of end-of-life care and moral distress. We analysed the interviews using thematic analysis.SettingAcademic teaching hospitals in the United States and United Kingdom.ParticipantsWe interviewed 30 physician trainees. We purposefully sampled across three domains we expected to be associated with individual ethics (stage of training, gender and national healthcare context) in order to elicit a diversity of ethical and experiential perspectives.ResultsSome trainees subscribed to a best interest ethical framework, characterised by offering recommendations consistent with the patient’s goals and values, presenting only medically appropriate choices and supporting shared decision-making between the patient/family and medical team. Others endorsed an autonomy framework, characterised by presenting all technologically feasible choices, refraining from offering recommendations and prioritising the voice of patient/family as the decision-maker.ConclusionsThis study describes how physician trainees conceptualise their roles as being rooted in an autonomy or best interest framework. Physician trainees have limited clinical experience and decision-making autonomy and may have ethical frameworks that are dynamic and potentially highly influenced by experiences providing end-of-life care. A better understanding of how individual physicians’ ethical frameworks influences the care they give provides opportunities to improve patient communication and advance the role of shared decision-making to ensure goal-aligned end-of-life care.

End-of-Life Care behind Bars

2002 ◽  
Vol 10 (3) ◽  
pp. 233-241 ◽  
Author(s):  
Phyllis B. Taylor
Keyword(s):  
United States ◽  
End Of Life ◽  
End Of Life Care ◽  
The United States ◽  
Chronic Illnesses ◽  
Direct Result ◽  
Life Care ◽  
Prison Health ◽  
The Many ◽  
Changing Demographics

More people than ever before are being incarcerated in the United States. Many inmates are infected with HIV and hepatitis C. Sentences are increasing in length. Prison health care is now having to cope with the many chronic illnesses associated with an ill and aging population. The growth of end-of-life care programs in corrections in the United States is a direct result of the changing demographics of inmates. This article examines the need for end-of-life care behind bars and discusses selected hospice programs.

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