Exploring primary care doctors’ perceptions on their roles in palliative care in Singapore: a qualitative study

Singapore faces a rapidly aging population with increasing multimorbidity, creating an urgent need for expanded palliative care services. Despite primary care physicians (PCPs) being ideally positioned to provide palliative care throughout patients’ disease trajectories, their role remains underdeveloped in Singapore’s healthcare system. This study aimed to explore PCPs’ perceptions of their roles in providing palliative care to patients with life-limiting illnesses in Singapore’s primary care setting. We conducted a qualitative study at two SingHealth Polyclinics with distinct patient population demographic profiles. Using purposive sampling, we recruited 20 PCPs with at least 12 months of primary care experience, representing various professional designations. Data were collected through in-depth interviews and focus group discussions from September to December 2023. All interviews were audio-recorded, transcribed verbatim, and analysed using a thematic approach. Our analysis revealed a dichotomy between PCPs’ recognition of their potential roles in palliative care and their reservations about fulfilling these responsibilities. While participants identified several important functions they could serve—including needs assessments, symptom management, advance care planning, psychosocial support, and care coordination—many expressed significant concerns about implementation. These perceptions were shaped by uncertainty regarding their place in the palliative care ecosystem, concerns about patient and specialist expectations, and personal comfort levels with end-of-life discussions. Additionally, some PCPs perceived that patients viewed them primarily as providers for routine or chronic care, not for managing complex end-of-life needs, which further affected their sense of role clarity in palliative care. PCPs in Singapore recognise their potential contributions to palliative care but experience uncertainty regarding their roles in current primary care settings. These perceptions are shaped by variability in training and experience, unclear role boundaries, and patient and specialist expectations. Strengthening role clarity, training, and collaboration with specialist services may support the integration of palliative care into primary care.