Factors influencing GPs’ perception of specialised palliative homecare (SPHC) importance – results of a cross-sectional study
Kathleen Stichling, Markus Krause, Bianka Ditscheid, Michaela Hach, Maximiliane Jansky, Manuela E. Kaufmann, Thomas Lehmann, Winfried Meißner, Friedemann Nauck, W Schneider, Sven Schulz, Horst Christian Vollmar, Ulrich Wedding, Jutta Bleidorn, Antje Freytag, the SAVOIR Study Group, Anna Bauer, L. Bergmann, Bianka Ditscheid, Cornelia Eichhorn, Antje Freytag, Michaela Hach, Ulrike Hammer, Aicko Helbig, Beata Hennig, Maximiliane Jansky, Michelle Kaufmann, Markus Krause, Sabine H. Krauss, Thomas Lehmann, Helmut L’Hoest, Srikanth Maddela, Ursula Marschall, Martial Mboulla, Winfried Meißner, Heiner Melching, Florian Mühler, Cornelia Nageler, Friedemann Nauck, J Rothaug, Joachim Saam, Werner Schneider, Sven Schulz, Kathleen Stichling, Horst Christian Vollmar, Julia von Hayek, Ulrich Wedding, Marie-Luise Völker, Vivienne Kley, Jana Feustel, Ketura Herklotz
Abstract
BACKGROUND: General Practitioners (GPs) are the main providers of primary palliative care (PPC). At the same time they are the main initiators of specialised palliative homecare (SPHC). In Germany, little is known about factors which influence GPs in their involvement of SPHC. Aim of our study is to identify factors that drive GPs to give value to and involve SPHC. METHODS: A cross-sectional survey was performed. In 2018, questionnaires were mailed to 6000 randomly selected GPs from eight German federal states, focusing on the extent of GPs' palliative care activities and their involvement of SPHC. RESULTS: With a response rate of 19.4% and exclusion of GPs working in SPHC-teams, n = 1026 questionnaires were appropriate for analysis. GPs valued SPHC support as the most "important/very important" for both "technical/invasive treatment measures" (95%) and availability outside practice opening hours (92%). The most relevant factor influencing perceived SPHC-importance was GPs' self-reported extent of engagement in palliative care (β = - 0.283; CI 95% = - 0.384;-0.182), followed by the perceived quality of utilised SPHC (β = 0.119; CI 95% = 0.048;0.190), involvement in treatment of palliative patients after SPHC initiation (β = 0.088; CI 95% = 0.042;0.134), and conviction that palliative care should be a central part of GPs' work (β = - 0.062; CI 95% = - 0.116;-0.008). Perceived SPHC-importance is also associated with SPHC-referrals (β =0.138; p < 0.001). The lower the engagement of GPs in palliative care, the more they involve SPHC and vice versa. CONCLUSIONS: GPs with low reported activity in palliative care are more likely to initialise SPHC for palliative care activities they do not deliver themselves for various reasons, which might mean that the involvement of SPHC is substitutive instead of complementary to primary palliative care. This finding and its interpretation should be given more attention in the future policy framework for (specialised) palliative homecare. TRIAL REGISTRATION: German Clinical Trials Register DRKS00014726 , 14.05.2018.