What challenges good palliative care provision out-of-hours? A qualitative interview study of out-of-hours general practitioners

BACKGROUND: Not much is known about how general practitioners (GPs) who work regular out-of-hours shifts in the community feel about prescribing medication for symptom control in end-of-life care patients, how they gain palliative care experience and what they perceive as benefits and hindrances within service delivery to this vulnerable patient and carer group. OBJECTIVES: To determine, by interviewing GPs who provide out-of-hours care, aspects of care provision that augmented or challenged palliative care delivery. METHODS: Semistructured interviews were conducted with GPs who worked out-of-hours shifts regularly. All interviews were analysed using interpretative phenomenological analysis. RESULTS: Out-of-hours doctors were not confident about their palliative care knowledge and expressed a wish for more education. Lack of familiarity with patients requiring acute palliative care, compared with the closer bonds formed within the in-hours general practice setting, was perceived as troublesome and problematic, and lack of follow-up was felt to be a major factor. There was a clearly expressed fear of killing or harming patients with the strong drugs used in palliative care. Opiophobia, especially when faced with patients who were seen only once, affected prescribing decisions. CONCLUSIONS: This study provides further evidence of the needs of a specific subgroup of GPs. In-depth interview analysis of their experiences with palliative care provides a framework for which aspects are perceived as a hindrance in providing good palliative care, and can inform out-of-hours policy and teaching.