What terminally ill patients value in the support provided by their GPs, district and Macmillan nurses.

The aim of this project was to investigate how patients view the care and support provided by their doctors and nurses. Forty-three patients with a life expectancy of 1 year or less who were being looked after in their own homes were asked to give their views of the support given by general practitioners, district nurses and Macmillan nurses. Patients had predominantly positive views of the support received. The content of their positive statements suggested that psychosocial aspects of support, including communication and kindness and consideration shown, were valued most. Actions in the form of helpfulness, organization of support and being accessible were also important, while clinical aspects received less emphasis. Clinical aspects of care were emphasized more when patients expressed negative views of support. Patients' statements suggested that emotional support and information were provided predominantly by Macmillan nurses. While useful guidelines exist for the provision of palliative care, these were often developed by health professionals for health professionals, and mainly gave advice on organization and coordination of care (Southwest Thames Regional Health Authority, 1991; Standing Medical Advisory Committee/ Standing Nursing and Midwifery Advisory Committee, 1992). In order to ensure that care provision is responsive to patients' needs we also need to know what constitutes good quality support from the patient's point of view in one-to-one interaction with health professionals, and what aspects of support are seen to be provided by whom. One way to improve our understanding of this is to ask patients to talk about the support provided by their doctors and nurses. As part of a project looking into domiciliary palliative care the authors investigated what patients valued about their doctors and nurses by noting which aspects they chose to emphasize when asked to explain what they felt was positive or negative about their support. Using qualitative analysis, the study focused on support from general practitioners (GPs), district nurses and Macmillan nurses as these were the health professionals found to be most involved in the patient's care. Full details are given in Grande (1994).