Implementation of Primary Palliative Care in five Belgian regions: A qualitative study on early identification of palliative care needs by general practitioners

Background:To deliver optimal palliative care, a Care Pathway for Primary Palliative Care(CPPPC) was developed. This CPPPC was implemented by general practitioners (GPs) in territo-ries of five Belgian palliative care networks (2014–2016). Belgian doctors have much therapeuticfreedom, and do not commonly follow guidelines.Objectives:To assess how palliative care was provided by GPs before the CPPPC and its imple-mentation project were presented publicly.Methods:Between 2013 and 2015, seven focus groups with GPs were conducted. Participantsincluded 15 GPs in three French-speaking focus groups and 26 GPs in four Dutch-speaking focusgroups, with diversity for age, gender, palliative care experience and practice context. Some GPsimplemented the CPPPC later.Results:GPs considered each palliative care case unique and disliked strict protocols. However,they expressed a need for peer review and reflective frameworks. GPs felt it is important toidentify palliative care patients‘timely’, but found this difficult. Screening methods help, but arenot widely used. GPs struggled most with identifying palliative care needs in non-oncologicalpatients. Bad news breaking was considered difficult. Continuity of care was considered veryimportant. However, advance care planning seemed more widely practised by Dutch-speakingGPs than by French-speaking GPs. The taboo of palliative care provoked emotional discussions.Conclusion:Palliative care frameworks which help GPs to deliver‘tailor-made’care have morechance to be adopted than strict protocols. GPs should be given education for bad news break-ing. Palliative care and advance care planning practices differ locally: guideline disseminationplans should respect these local differences