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Table 4 GPs’ perceived training needs

From: Primary care physicians’ educational needs and learning preferences in end of life care: A focus group study in the UK

Training need

Exemplifying quotation

Identifying and referring patients for palliative care

‘Identifying which patients need to be highlighted and prioritising those patients… I don't think we really do that very well. I think they slip through the net quite easily.’ (GP19)

‘Whether everyone needs to be referred to palliative care, or if there are people that we can manage in the community without input, if we feel comfortable enough – I wouldn't know that decision. I would always refer, because… I'm not comfortable with any of the medications.’ (GP30)

Local services and resources

“Practical things - what do you actually do, who do you actually phone up, who’s involved in that team… there must be… all kinds of services going on that we just don’t know about… that would be useful, to see ‘these are all the people, these are all the resources you potentially use and this is how you get hold of them.’” (GP02)

Local systems and frameworks

‘How does this system work in my locality? How do I contact this person? What advice, specifically, do I give? What are the guidelines in my area? Where do I access them? That kind of thing.’ (GP29)

“In my practice, some people don't know about hospital at home. So I’ve sent an email round saying, do you know you can do this? It is really interesting. You will have five GPs and only one will know about hospital at home or only one will know about ‘Talk Kings’ where you can get 24 h access to a consultant. And it is like it is really bitty how we get our information.” (GP09)

Roles, responsibilities and team work

‘You’ve got your role in their care, but knowing what you can legitimately expect of other team members, and what it's not bad to ask them to do, or what they may offer in terms of support and things, I think that's quite important, because I don't feel like I've got a good grasp of exactly what everyone could do in that team.’ (GP19)

Out-of-hours care

‘I have had some phone calls about palliative patients in out of hours that [are]… more challenging because you really just don’t have any, well, very little background.’ (GP25)

Difficult conversations and counselling skills

‘I don't feel particularly skilled and I find it especially difficult if you've been with - if you've known a family for years… but then you realise that, Dad's actually… this is the beginning of his dying process… how do you have that first conversation?’ (GP02)

‘We’re all expected to be counsellors, although none of us have had any counselling training, so if there were some sort of people from the mental health team or counsellors that could come in and offer… sessions… that would be useful.’ (GP03)

Symptom management

‘I know a drug chart, whenever I get one, I get really flustered because there are rules and criteria and different things.’ (GP09)

‘For me it is all the practical stuff that you guys mentioned, like drug doses and these whacking great doses of morphine and is it saline or is it water or whatever.’ (GP16)

Caring for patients with non-malignant conditions

‘It is easier when they have got a terminal diagnosis like a cancer or something. When they have lots of comorbidities and they are just starting to fail, that is really hard.’ (GP13)

Paediatric palliative care

‘Paediatric terminal care, it's something that, thankfully, we don't see very much of and in fact are very ill equipped to deal with I think… on the rare occasion that it does come, come along.’ (GP03)