Exploring the practical experiences and perspectives of community clinic physicians in home-based palliative care: a qualitative study

This is the authors' abstract. We don't add key points for this paper.

As attention to end-of-life care has increased globally, palliative care has become an important interprofessional healthcare model, with growing interest in home-based palliative care (HBPC). Although Taiwan is internationally recognized for the quality of its end-of-life care, HBPC utilization remains low. To expand service capacity, the Ministry of Health and Welfare has promoted Type B HBPC, a community-based model in which primary care physicians and community nurses provide care with support from hospital-based palliative care teams. However, participation is constrained by time demands, limited resources, and challenges in interprofessional collaboration. This qualitative study explored community physicians’ experiences and perspectives on Type B HBPC to identify challenges, facilitators, and opportunities for service and policy improvement. Eight community physicians were recruited through purposive sampling and participated in individual, in-depth semi-structured interviews. Data were analyzed using inductive thematic analysis. Seven themes were identified: (1) Opportunities, (2) Benefits, (3) Teamwork, (4) Challenges, (5) Policies, (6) Adaptation, and (7) Expectations. Physicians entered HBPC through policy initiatives, professional networks, and personal experiences. They recognized benefits for patients, families, the healthcare system, and their own professional fulfilment and relied on multidisciplinary collaboration. They reported challenges involving time demands, limited clinical confidence, emotional burden, logistical constraints, reimbursement, and administrative requirements, and described adaptive strategies to sustain practice. Participants anticipated that stronger community-hospital collaboration, more supportive policies, and continued professional development would strengthen community HBPC in Taiwan. Physicians participating in Type B HBPC generally viewed their work positively and described substantial professional fulfilment. However, inadequate reimbursement, complex national health insurance (NHI) review procedures, limited continuing education opportunities for community physicians and home care nurses, and the absence of additional reimbursement for supporting hospitals were perceived as barriers to sustainable collaboration. More supportive NHI policies, enhanced continuing education, and greater professional exchange may help establish a more effective community-based palliative care network.