Danish general practitioners’ self-reported competences in end-of-life care

Abstract

Objective: General practitioners (GPs) are pivotal in end-of-life (EOL) care. This study aimed to assess GP-reported provision of EOL care and to assess associations with GP characteristics.

Design: Population-based questionnaire study.

Setting: Central Denmark Region with approximately 1.3 million inhabitants.

Subjects: All 843 active GPs in the Central Denmark Region were sent a questionnaire by mail.

Main outcome measures: Responses to 18 items concerning four aspects: provision of EOL care to patients with different diagnosis, confidence with being a key worker, organisation of EOL care and EOL skills (medical and psychosocial).

Results: In total, 573 (68%) GPs responded. Of these, 85% often/always offered EOL care to cancer patients, which was twice as often as to patients with non-malignancies (34–40%). Moreover, 76% felt confident about being a key worker, 60% had a proactive approach, and 58% talked to their patients about dying. Only 9% kept a register of patients with EOL needs, and 19% had specific EOL procedures. GP confidence with own EOL skills varied; from 55% feeling confident using terminal medications to 90% feeling confident treating nausea/vomiting. Increasing GP age was associated with increased confidence about being a key worker and provision of EOL care to patients with non-malignancies. In rural areas, GPs were more confident about administering medicine subcutaneously than in urban areas.

Conclusion: We found considerable diversity in self-reported EOL care competences. Interventions should focus on increasing GPs’ provision of EOL care to patients with non-malignancies, promoting better EOL care concerning organisation and symptom management.

KEY POINTS

• GPs are pivotal in end-of-life (EOL) care, but their involvement has been questioned. Hence, GPs’ perceived competencies were explored.

• GPs were twice as likely to provide EOL care for patients with cancer than for patients with non-malignancies.

• EOL care was lacking clear organisation in general practice in terms of registering palliative patients and having specific EOL procedures.

• GPs were generally least confident with their skills in terminal medical treatment, for example, using medicine administered subcutaneously.

Keywords:

• Denmark
• general practice
• palliative care
• COPD
• heart failure
• case management
• clinical competence

Ethics approval

According to the Committee on Health Research Ethics in the Central Denmark Region, this study needed no approval from this committee (file no. 31/2013). The Danish Data Protection Agency (File. no. 2013-41-1965) and the Multi-Practice Committee of the Danish College of General Practitioners (MPU 02-2014) approved the study.

Acknowledgements

We wish to thank all the participating GPs. At the Research Centre for Cancer Diagnosis in Primary Care, Research Unit for General Practice, Aarhus University, Denmark, we want to thank data manager Kaare Rud Flarup for setting up the questionnaires and Lone Niedziella for linguistic support. Finally, we want to thank the Committee of Quality and continuing education, Central Denmark Region for support and acknowledgment for the importance of the study.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Funding

Danish Cancer Society and the Danish foundation TrygFonden supported the work through the joint grant ‘Safety in Palliative Care’ [Tryghed i palliative forløb]. The Committee for Quality Improvement and Continuing Medical Education of the Central Denmark Region paid compensation to participating GPs.