Experiences from Patients in the Palliative Phase with Symptom Control and Communication in Primary Care

ackground/aims: Appropriate palliative care requires multidimensional symptom management, provided by a multiprofessional team.
The working method “Palliative Reasoning” (PR), was developed and
implemented in primary care. PRcontributes to improved communication and symptom control.
Aim: Insight into the experience of patients with a life limiting illness
after with the implementation of PR in primary care.
Methods: Semi-structured interviews were performed with 12 patients in
the palliative phase, purposefully recruited from a Dutch home care organization. Outcomes were multidimensional symptom control and communication. This qualitative study included a thematic analysis method.
Results: Four main themes were found, involving wishes and needs, feeling safe, proactivity, and continuity. Patient-related factors can influence
the experience of symptom control, such as knowledge, awareness and
relative stability of the disease. Healthcare professionals (HCPs)
improved feelings of safety through the established relationship, accessibility, and communication. Often, HCPs were proactive in identifying
physical symptoms and reacting accordingly. Transparency was achieved
through shared decision-making, which contributed to the continuity of
care. Communication between HCPs was less visible to patients but was
often assumed to be well established.
Conclusions: Patients experienced improved symptom control with a
greater knowledge and awareness of their disease after the implementation of PR. The proactive attitude of HCPs, continuity of care, and feelings of safety contributed to symptom control and transparent
communication. For clinical practice, the palliative care process can be
improved by patient involvement and transparent communication and
committed attitude of HCPs