Conditions of Palliative Home Care: The Case of Family Physicians in Switzerland.
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Family physicians (FPs) play a key role in the treatment and care for terminally ill men and women. However, little is known about the conditions and challenges of FPs services in this domain. Aim of this article is to identify, how FPs can be supported in palliative home care in Switzerland by the availability of guidelines and advance directives, community-based palliative care structures, education and training, as well as remuneration of palliative home care services. Case studies in three Swiss cantons, namely Lucerne (LU), Vaud (VD), and Ticino (TI) are the basis of the following investigation. They not only represent French, Italian and German language regions but differ considerably with respect to the history of palliative care. Within and between cantons documents, questionnaires and expert interviews are analyzed thematically with the help of content-analysis. The results illustrate considerable shortcomings with respect to the backing of FPs palliative home care services. The availability and use of guidelines as well as advance directives is rather small in general practice, and FPs care and treatment at the end of life is only marginally supported by ambulant care structures, especially in rural areas. Also the coordination of services and collaboration between specialists and generalists is poorly developed. Furthermore FPs possibilities to acquire competencies in palliative care are strongly limited, and palliative home care provided by FPs is poorly financed. The results draw a rather bleak picture with respect to the support of FPs palliative home care services in Switzerland today. Though considerable steps towards implementing palliative care have been made in recent years in general, conditions for FPs medical services have to get improvedstrongly. Major efforts have to be made to foster the recognition and implementation throughout Switzerland.