What challenges do Thai general practitioners and family physicians confront when discussing advance care planning with palliative care patients and families?:A qualitative study

Abstract

Background: The end-of-life decisions are not solely made based on patient’s autonomy. This procedure creates challenges for Thai primary care physicians to discuss an advance care plan with patients and families.Objective: To understand the challenges for physicians in discussing advance care plan at the end of life. method: In-depth interviews were conducted with coding and thematic analysis performed by three independent investigators.Results: Twenty primary care physicians (10 male, 10 female) were interviewed.Nineteen physicians recognized the importance of an advance care plan as a "life map" “incorporation into ID card" and "early plan in advance”. Physicians faced 3 major challenges physician’s own factors, patients and families’ factors, and the health care system. General physicians reported a lack of knowledge in symptom palliation and misconception of palliative care is as inactive care. Family physicians had to set up a comprehensive palliative care system on their own and were confronted with the conspiracy of silence in the family. Lastly, the Thai health care system predominated with the disease-oriented model of care, patient overload, and difficult coordinating care with specialists. Despite having legal support for advance directives, it is still in early-stage with lack of family physicians.Conclusion: Thai primary physicians face three major challenges in advance care planning including physicians’ own factors, patients’ and families’ factors and the disease-oriented health care system.