Family physicians' integration of palliative principles in cirrhosis care: a cognitive task analysis study of symptom management.

BACKGROUND: Family physicians often hold reactive, case-by-case mental models for cirrhosis care due to systemic gaps in coordination, continuity, and transitions of care. Confusion may also exist between palliative and end-of-life care, with uncertainty around the timing of conversations with patients. Examining how family physicians approach symptom management with patients living with cirrhosis may provide insights into how they incorporate palliative principles of care. This study aims to elicit and explore family physicians' mental models of symptom management in cirrhosis care to reveal if palliative principles are integrated into primary care practice.

METHODS: A cross-sectional formal elicitation of mental models was conducted using Cognitive Task Analysis. We used purposive sampling of family physicians (n = 6) who saw small numbers, typical for unspecialized practice, of cirrhosis patients in Alberta, Canada.

RESULTS: Lack of continuity in cirrhosis care obliges physicians to hold reactive mental models of symptom management. This, with the confusion between palliative and end-of-life care, causes uncertainty around when and how to have conversations about advanced care planning and end-of-life care. Physicians expressed a desire for tools, processes, and education to fit palliative principles into their care.

CONCLUSIONS: Without formal processes and structures in place, family physicians will continue to hold reactive mental models of cirrhosis management, often lacking fully integrated palliative principles. Family physicians and care teams require support to guide when and how to have conversations about advanced care planning with patients, family, and caregivers at the time of diagnosis, and throughout the trajectory of the illness.