Challenges of general practitioner-oncologist interaction in end-of-life communication: a qualitative study

Abstract Purpose: To explore general practitioners‘ (GP) perspectives on initiation and conduction of end-of-life (EOL) conversations in patients with metastatic lung cancer and how they perceive the interaction with the oncologists of a cancer center. Methods: Qualitative design with in-depth interviews with GPs that refer patients with metastatic lung cancer to a cancer center; thematic analysis following Braun and Clarke. Results: We identified three main themes: timing and conduction of EOL-conversations, factors influencing EOL-conversations, and modes of GP-oncologist interaction. All themes showed important challenges in regard to communication strategies or procedures within the cancer center and between general practitioners and oncologists. Aside from known challenges of EOL-communication, important problems arise from the difficulties in keeping pace with advances in oncology and the increasing prognostic uncertainty. Additionally, the lack of standardized communication in EOL-topics between GPs and oncologists is underlined. Options in the mode of interaction include written information and direct phone calls. Conclusions: Because of the growing complexity in modern oncology, strategies for improvement in EOL-communication and GP-oncologist interaction have to consider information and education about therapeutic advances and prognosis of patients. The written interaction in reports or digital platforms should include information about EOL-communication. As prognostic uncertainty may hinder the adequate provision and conduction of conversations, a trustful personal interaction through direct contact via phone calls between GPs and oncologists should be encouraged.