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

Authors

  • Pimarporn Saimmai,M.D. Faculty of Medicine, Ramathibodi Hospital, Mahidol University
  • Saipin Hathirat, M.D Faculty of Medicine, Ramathibodi Hospital, Mahidol University,
  • Kittiphon Nagaviroj, M.D. Faculty of Medicine, Ramathibodi Hospital, Mahidol University

Keywords:

advance care plan, advance care plan, palliative care, challenges of physician

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.

 

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References

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Published

31-03-2022

How to Cite

1.
Saimmai P, Hathirat S, Nagaviroj K. What challenges do Thai general practitioners and family physicians confront when discussing advance care planning with palliative care patients and families?:A qualitative study. j dept med ser [Internet]. 2022 Mar. 31 [cited 2022 Sep. 25];47(1):94-102. Available from: https://he02.tci-thaijo.org/index.php/JDMS/article/view/252203

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Section

Original Article