General practitioners attitudes concerning end-of-life situations in patients' homes

OBJECTIVES: General practitioners (GPs) are directly confronted with patien ts experiencing end-of-life situations in their homes. We conducted a surve y to ascertain the GPs' approach as there has been little work in France co ncerning this type of situation. METHODS: A questionnaire was sent to 478 general practitioners in the Esson ne 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. Proble ms related to end-of-life situations are discussed with persons close to pa tients with incurable conditions (for 85% of the responding GPs)and with th e patient (74%). Patients participating in the discussion express the desir e 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 i s the number one reason for hospitalization. This contrasts with the opinio n of general practitioners who favor home management (82% of the responding physicians). CONCLUSION: Our study demonstrates an important gap in medical education si nce 66.5% of the practitioners felt they had not received appropriate train ing in this area. it also emphasizes the lack of sufficient communication b etween general practitioners and hospital physicians and the need to organi ze a network which would better respond to patient,family, and physician de mands.