Palliative care case conferencing involving general practice: an argument for a facilitated standard process

Objective. To discuss the results of a qualitative analysis of the group dynamics of General Practitioner (GP)-led case conferences for palliative care patients, where the GP becomes the care coordinator. Two outcomes are sought: (1) raise the understanding of this type of case conferencing for palliative care patients; and (2) recommend improvements to this process that will positively affect its efficacy. Methods. Original data is the qualitative component of quantitative and qualitative study of 17 GP-led case conferences for palliative care patients. Data were analysed using Carney’s Ladder of Analytical Abstraction. Results. Analysis produced four persistent themes: ambiguity of purpose; ambiguity of role; lack of information; and involvement of multiple interconnected and dynamic groups. These themes are a natural result of the case conferencing process that occurred during the study. Conclusion. Case conferences were inherently uncertain and complex. Complexity results from the range of people and groups interacting with the patient before the case conference who do not attend the conference. Uncertainty results from a lack of direction, leadership and agreed outcomes against which the conference can be structured and measured. A standard process facilitated by someone other than the GP and containing necessary information would offer a better chance of optimising this process. What is known about the topic? Little is known of the group dynamics that occur during these case conferences. What does this paper add? This paper adds a first assessment of the group dynamics of the process and discloses issues that will need to be addressed if this type of case conferencing is to be optimised. What are the implications for practitioners? Understanding of fundamental issues with the process.