Relatives; Assessment of care provision and quality; Switzerland; End-of-life care; General practitioners; Palliative care
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In Switzerland general practitioners (GPs) are the primary and most important resource for nearly all health problems. End-of-life care is therefore one of the core competencies of Swiss GPs. Recent and impending reforms of care and its financing intend to reinforce the community-based care and gatekeeper functions of GPs. At the same time, prosperity and modern medicine lead to increasing life expectancies and an aging society. Patients’ multimorbidity, frailty, disabilities and positive advancement within their complex medical, social and financial conditions are challenges for the community-based care. Palliative care, especially end-of-life care, is an important approach to meet the needs of terminally ill and dying patients and their relatives. It will play an increasingly important role in the future work of GPs.This nationwide qualitative-quantitative study shall examine the present reality and quality of community-based end-of-life care according to GPs themselves as well as by families directly involved. Present implicit (and if existing explicit) quality standards in Switzerland will be critically evaluated based on experiences of other countries. STUDY PORPOSE: The aim of the survey is to identify and assess central aspects of end-of-life care as delivered by Swiss GPs including gaps that should be filled in the future. Special focus is placed on the scarcity of primary care resources and on barriers to and gaps in GP supply for terminally ill and dying patients. STUDY METHODOLOGY: The study consists of a multi-level line of action, combining qualitative and quantitative methods. After a literature review (phase I), 30 semi-structured interviews with general practitioners are conducted (phase II.1A) followed by three focus groups with GPs in different parts of Switzerland (phase II.1B). In parallel, a questionnaire for the bereaved relatives’ points of view concerning provision gaps in end-of-life care is disseminated (phase II.2). Finally, a large-scale questionnaire for general practitioners in all parts of Switzerland (N=6000) will be developed (phase III).IMPORTANCE AND IMPACT OF THE STUDY: The framework conditions and quality of community-based end-of-life care are examined and leading aspects of end-of-life care as delivered by general practitioners in Switzerland assessed. The focus lies especially on the lack of primary care resources and barriers to and gaps of GP supply for terminally ill and dying patients. The findings are expected to be of great social and economic significance that can generate important impulses for action: support for provision of a baseline for demand-oriented and efficient patient trajectories; promotion of better, more supportive care for terminally ill and dying patients and their relatives in the setting of community healthcare; strengthening of the importance of the primary care sector.