Barriers facing family physicians providing palliative care service in Hong Kong: a questionnaire survey

Abstract

Objective: To investigate willingness and barriers for family physicians to provide palliative care service in Hong Kong. Design: A combined qualitative and quantitative research method. Subjects: All local members of the Hong Kong College of Family Physicians (HKCFP). Main outcome measures: Demographic data, ideas and factors concerning provision of palliative care in Hong Kong. Generalised Estimating Equations (GEE) model and Logistic Regression analysis to determine factors affecting doctor’s wish and the actual provision of palliative care in practice. Results: Overall, 750 (48.1%) responses from respondents with a similar distribution in age and gender profile as our target population were returned. General barriers identified were time concern and not enough support from various disciplines. Specific barriers affecting actual provision of service were knowledge and experience (p<0.001), problems dealing with death (p=0.013), current public-private interface (p=0.016) and cultural concerns (p=0.022). Having an interest (p=0.002), continuity of care (p<0.001), patient needs (p<0.001), having a specialist qualification(p=0.009) and primary qualification obtained in Canada (p=0.001) were found to be supporting factors for willingness and actually providing palliative care in their practice. Conclusion: The factors and suggestions learned from this study should be addressed if collaboration between palliative care and primary care is considered for community palliative care service in Hong Kong. Further studies focusing on patients and their family members’ perspectives are essential to understand the actual need in our cultural context.

目的：研究香港基層醫生對提供紓緩治療的意願和在實行時面對的障礙。 設計：混合質量和數量方式。 對象：所有香港家庭醫學學院的本地成員。 主要測量內容：人口統計數據，想法和影響在港提供紓緩治療的因素。以歸納性估計方程式（GEE）和邏輯回歸分析法斷定影響醫生的意願和實行紓緩治療的各種因素。 結果：整體有750位（48.1%）成員回覆，其年歲和性別概況跟目標對象相似。對回覆者的觀點和在基層醫療進行紓緩治療的實踐作分析。一般障礙為時間考量和缺乏支援。具體障礙為知識和經驗方面的考量（P<0.001），處理病人面對死亡時的困難P=0.013），目前公私營醫療系統介面上的溝通（P=0.016）和文化上的顧慮（P=0.0022）。興趣（P=0.002）， 持續治療（P<0.001）， 病人需求（P< 0. 001）， 專科資格（P= 0. 009） 和在加拿大培訓（P=0.001）都是推動醫生提供紓緩治療的正面因素。 結論：若考慮將紓緩療法與基層醫療結合，在香港提供社區紓緩治療服務，文中提及的各種因素和建議應受到正視。此外，亦需在本地文化環境下，對病人及其家人的觀點作進一步專項研究以了解他們的實際需要。