Decision-making in general practice settings at the end of life

Primary care physicians (general practitioners) play an important role in the support of terminally ill or dying patients. Together with patients, family members and nursing staff, they have to make decisions when it comes to admission to hospital or hospice, symptom relief or with-drawing treatment. Today we still know little about the prerequisites and challenges of decision-making on palliative care in general practice settings.

The study aims to investigate decision-making at the end of life, taking into consideration the primary care physician–patient relationship, communication with family members and co-operation with nursing staff, family members and hospitals. In addition, it will examine how important legal regulations, different supply structures across the cantons, patient advance directives and normative notions of "good dying" are for decisions at the end of life. In addition to analysis of the framework conditions of primary care at the end of life at the cantonal and national levels, the research team will interview health policy actors, patient organisations and representative primary care physicians and nursing staff. Further, primary care physicians, nursing staff and family members of dying persons from the German-, French-, and Italian-speaking parts of Switzerland will be surveyed in group discussions on the conditions and processes of decision-making at the end of life. The analysis of the interviews will uncover central factors and indicators for successful decision-making on palliative care in general practice settings.

The results of the study will contribute towards improving palliative care in general practice settings in Switzerland by identifying the necessary competencies on the part of primary care physicians for optimal decision-making and by describing the conditions and challenges of palliative support at the end of life.

Decision Making Practice at the End of Life. The Case of General Practice.