Psychological stress of general practitioners in the care of patients with palliative care needs: an exploratory study

1. Background and aims of this study General practitioners (GPs) in Germany play a central role in the care of individuals at the end of life. The desire of many patients to die at home often reinforces the palliative engagement of GPs. In this context, they frequently serve as the first point of contact—not only for medical issues, but also for emotional and organizational concerns. This role is supported by the often long-standing trust developed through years of continuous care relationships. At the same time, caring for patients at the end of life can lead to challenging and potentially psychologically and emotionally burdensome situations for the physicians involved. This is particularly relevant in light of legal uncertainties surrounding medical decisions at the end of life. Although dying is a universal human experience, there are significant individual differences in how people engage with this stage of life—especially with regard to advance care planning in situations where individuals may no longer be able to make decisions for themselves. The concept of Advance Care Planning (ACP) provides a structured approach to addressing this sensitive issue. However, it remains unclear how GPs assess the potential of such programs and to what extent they implement them in practice. The aim of this study is to explore the role of end-of-life care in the everyday practice of general practitioners, to identify the burdens arising from this aspect of care, to understand how GPs cope with these stressors, and to examine the perceived opportunities and challenges associated with ACP. 2. Methods This study is designed as an exploratory investigation, consisting of a short questionnaire and semistructured individual interviews. The study population comprises 11 general practitioners from Bavaria, who are either currently in practice or have retired within the past year. Data analysis was conducted using a structured qualitative content analysis, applying a combined deductive–inductive approach. The theoretical framework is based on a combination of the stress–strain model developed by Rohmert and Rutenfranz and the Transactional Model of Stress by Lazarus. 3. Results The participating general practitioners perceived palliative care as an integral part of their professional responsibilities. Various challenges were identified in this context, most notably a lack of time and insufficient expertise in the field of palliative medicine. Additional barriers included difficulties in initiating conversations about end-of-life issues, which were attributed to the societal taboo surrounding death and dying. Several participants reported emotionally distressing experiences associated with their palliative care activities. Coping strategies included both problem-focused approaches (e.g., avoiding negative stressors, structuring the workday) and emotion-focused strategies (e.g., collegial exchange). A lack of targeted psychological support services for GPs was explicitly criticized. Most participants were not familiar with the concept of Advance Care Planning (ACP), but recognized its potential to reduce burden in end-of-life care. 4. Conclusion Palliative care consultations and treatment situations can lead to significant psychological strain for general practitioners, particularly when external stressors such as time pressure or uncertainty are present. Future research should further explore and, where appropriate, implement measures aimed at reducing psychological burden, in order to better support GPs in managing challenging situations. Furthermore, the concept of advance care planning (ACP) should be more firmly established and investigated within general practice settings—both with regard to its potential for reducing strain and in terms of identifying barriers to its practical implementation.