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


  • 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


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


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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How to Cite

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



Original Article