Palliative care by family physicians in the 1990s. Resilience amid reform

Objective. To explore issues family physicians face in providing community-based palliative care to their patients in the context of a changing health care system. Design Focus groups. Setting. Small (< 10 000 population), medium-sized (10 000 to 50 000), and large (> 50 000) communities in Nova Scotia. Participants. Twenty-five men and women physicians with varying years of practice experience in both solo and group practices. Method. A semistructured approach was used, asking physicians to reflect on recent palliative care experiences in order to explore issues of care. Main Findings. Five themes emerged from the discussions: resources needed, availability of family support, time and money supporting physicians' activities, symptom control for patients, and physicians' emotional reactions to caring for dying patients. Conclusion. With downsizing of hospitals and greater emphasis on community-based care, the issues identified in this study will need attention, particularly in designing an integrated service delivery model for palliative care.