Yes, But It’s Somewhat Difficult-Managing End of Life Care in Primary Health Care

摘要

A qualitative study was undertaken to investigate the perceptions of General Practitioners regarding the management of older people with heart failure, particularly at the end of life. Semi-structured interviews were conducted with 30 General Practitioners in Auckland, New Zealand during 2008. Participants identified that the needs of older patients with heart failure could not be addressed in isolation from the wider issues which affect older people. This complexity influenced all components of patient need including the typical course of the disease, the provision of prognostic and end of life information, and how palliative care was provided, including referral to specialist services. Some participants also believed that older people’s palliative care management should be approached differently to that of younger people stating, for example, that they were concerned about the amount of information older people could take in. A model which takes into consideration the experiences of the older person and fits them into, not a ‘dying model’ but a ‘life model’, one that supports the natural transition to end of life is needed. A ‘life planning model’ used early in the management of patients would be a useful way forward and one which would allow the integration of the different paradigms of cardiology, gerontology, palliative care and nursing.