Issues in End-of-Life Care.

BACKGROUND. Issues in end-of-life care in the United States are receiving increasing discussion in light of the aging population and the documented need to improve the quality of care for dying patients and their families. Family practice faculty are in a key position to contribute valuable information, given their missions to model necessary values, attitudes, and skills and directly teach quality end-of-life care. METHODS. We conducted interviews with 20 family practice faculty members in 3 residencies, and verbatim transcripts were coded by the authors. We held a second round of 12 interviews in 3 different residencies to check validity and expand the themes emerging from the original interviews. Corrected and elaborated themes were presented to focus groups from 2 other residencies. RESULTS. Themes of reaching consensus; establishing a treatment plan; mobilizing a caregiving system; dealing with relationships with patients, families, and the treatment team; and issues of personal domain were described as important in end-of-life care. CONCLUSIONS. The discussion of quality end-of-life care and how to provide it emphasized traditional medical concerns of diagnosis and prognosis, treatment, and caregiver support. Opportunities for innovation and improvement exist within the less explored areas of the relationship between the provider, patient, and family, and issues of personal meaning and experience. [ABSTRACT FROM AUTHOR]