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'It is not the fading candle that one expects': general practitioner's perspectives on life-preserving versus 'letting go' decision-making in end-of-life home care

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Abstract
Background: Many general practitioners (GPs) are willing to provide end-of-life (EoL) home care for their patients. International research on GPs' approach to care in patients' final weeks of life showed a combination of palliative measures with life-preserving actions. Aim: To explore the GP's perspective on life-preserving versus letting go decision-making in EoL home care. Design: Qualitative analysis of semi-structured interviews with 52 Belgian GPs involved in EoL home care. Results: Nearly all GPs adopted a palliative approach and an accepting attitude towards death. The erratic course of terminal illness can challenge this approach. Disruptive medical events threaten the prospect of a peaceful end-phase and death at home and force the GP either to maintain the patient's (quality of) life for the time being or to recognize the event as a step to life closure and letting the patient go. Making the right decision was very difficult. Influencing factors included: the nature and time of the crisis, a patient's clinical condition at the event itself, a GP's level of determination in deciding and negotiating letting go and the patient's/family's wishes and preparedness regarding this death. Hospitalization was often a way out. Conclusions: GPs regard alternation between palliation and life-preservation as part of palliative care. They feel uncertain about their mandate in deciding and negotiating the final step to life closure. A shortage of knowledge of (acute) palliative medicine as one cause of difficulties in letting-go decisions may be underestimated. Sharing all these professional responsibilities with the specialist palliative home care teams would lighten a GP's burden considerably.
Keywords
letting go, hospice care, terminal care, PALLIATIVE CARE, home care, general practitioner, general practice, family physician, end-of-life care, decision-making, Belgium, CANCER-PATIENTS, DEATH, OPPORTUNITIES, TRANSITIONS, CHALLENGES, PLACE

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MLA
Sercu, Marij et al. “‘It Is Not the Fading Candle That One Expects’: General Practitioner’s Perspectives on Life-preserving Versus ‘Letting Go’ Decision-making in End-of-life Home Care.” SCANDINAVIAN JOURNAL OF PRIMARY HEALTH CARE 33.4 (2015): 233–242. Print.
APA
Sercu, Marij, Van Renterghem, V., Pype, P., Aelbrecht, K., Derese, A., & Deveugele, M. (2015). “It is not the fading candle that one expects”: general practitioner’s perspectives on life-preserving versus “letting go” decision-making in end-of-life home care. SCANDINAVIAN JOURNAL OF PRIMARY HEALTH CARE, 33(4), 233–242.
Chicago author-date
Sercu, Marij, Veerle Van Renterghem, Peter Pype, Karolien Aelbrecht, Anselme Derese, and Myriam Deveugele. 2015. “‘It Is Not the Fading Candle That One Expects’: General Practitioner’s Perspectives on Life-preserving Versus ‘Letting Go’ Decision-making in End-of-life Home Care.” Scandinavian Journal of Primary Health Care 33 (4): 233–242.
Chicago author-date (all authors)
Sercu, Marij, Veerle Van Renterghem, Peter Pype, Karolien Aelbrecht, Anselme Derese, and Myriam Deveugele. 2015. “‘It Is Not the Fading Candle That One Expects’: General Practitioner’s Perspectives on Life-preserving Versus ‘Letting Go’ Decision-making in End-of-life Home Care.” Scandinavian Journal of Primary Health Care 33 (4): 233–242.
Vancouver
1.
Sercu M, Van Renterghem V, Pype P, Aelbrecht K, Derese A, Deveugele M. “It is not the fading candle that one expects”: general practitioner’s perspectives on life-preserving versus “letting go” decision-making in end-of-life home care. SCANDINAVIAN JOURNAL OF PRIMARY HEALTH CARE. 2015;33(4):233–42.
IEEE
[1]
M. Sercu, V. Van Renterghem, P. Pype, K. Aelbrecht, A. Derese, and M. Deveugele, “‘It is not the fading candle that one expects’: general practitioner’s perspectives on life-preserving versus ‘letting go’ decision-making in end-of-life home care,” SCANDINAVIAN JOURNAL OF PRIMARY HEALTH CARE, vol. 33, no. 4, pp. 233–242, 2015.
@article{7019665,
  abstract     = {Background: Many general practitioners (GPs) are willing to provide end-of-life (EoL) home care for their patients. International research on GPs' approach to care in patients' final weeks of life showed a combination of palliative measures with life-preserving actions.
Aim: To explore the GP's perspective on life-preserving versus letting go decision-making in EoL home care.
Design: Qualitative analysis of semi-structured interviews with 52 Belgian GPs involved in EoL home care.
Results: Nearly all GPs adopted a palliative approach and an accepting attitude towards death. The erratic course of terminal illness can challenge this approach. Disruptive medical events threaten the prospect of a peaceful end-phase and death at home and force the GP either to maintain the patient's (quality of) life for the time being or to recognize the event as a step to life closure and letting the patient go. Making the right decision was very difficult. Influencing factors included: the nature and time of the crisis, a patient's clinical condition at the event itself, a GP's level of determination in deciding and negotiating letting go and the patient's/family's wishes and preparedness regarding this death. Hospitalization was often a way out.
Conclusions: GPs regard alternation between palliation and life-preservation as part of palliative care. They feel uncertain about their mandate in deciding and negotiating the final step to life closure. A shortage of knowledge of (acute) palliative medicine as one cause of difficulties in letting-go decisions may be underestimated. Sharing all these professional responsibilities with the specialist palliative home care teams would lighten a GP's burden considerably.},
  author       = {Sercu, Marij and Van Renterghem, Veerle and Pype, Peter and Aelbrecht, Karolien and Derese, Anselme and Deveugele, Myriam},
  issn         = {0281-3432},
  journal      = {SCANDINAVIAN JOURNAL OF PRIMARY HEALTH CARE},
  keywords     = {letting go,hospice care,terminal care,PALLIATIVE CARE,home care,general practitioner,general practice,family physician,end-of-life care,decision-making,Belgium,CANCER-PATIENTS,DEATH,OPPORTUNITIES,TRANSITIONS,CHALLENGES,PLACE},
  language     = {eng},
  number       = {4},
  pages        = {233--242},
  title        = {'It is not the fading candle that one expects': general practitioner's perspectives on life-preserving versus 'letting go' decision-making in end-of-life home care},
  url          = {http://dx.doi.org/10.3109/02813432.2015.1118837},
  volume       = {33},
  year         = {2015},
}

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