[Attitude of general practitioners facing patients at the end of life in home care]

Abstract

Objectives: General practitioners (GPs) are directly confronted with patients experiencing end-of-life situations in their homes. We conducted a survey to ascertain the GPs' approach as there has been little work in France concerning this type of situation.

Methods: A questionnaire was sent to 478 general practitioners in the Essonne department who are corresponding physicians at the Louis-Michel hospital in Evry. There were 233 responses (49.8%).

Results: The main findings demonstrated that important decisions concerning dying patients are made on a consensus basis in 58.8% of the cases. Problems related to end-of-life situations are discussed with persons close to patients with incurable conditions (for 85% of the responding GPs) and with the patient (74%). Patients participating in the discussion express the desire to continue living in 65.7% of the cases. The familial situation appears to be the essential element for managing these patients in their home and is the number one reason for hospitalization. This contrasts with the opinion of general practitioners who favor home management (82% of the responding physicians).

Conclusion: Our study demonstrates an important gap in medical education since 66.5% of the practitioners felt they had not received appropriate training in this area. It also emphasizes the lack of sufficient communication between general practitioners and hospital physicians and the need to organize a network which would better respond to patient, family, and physician demands.