General practitioners' relational familiarity with home-dwelling patients in the palliative phase: Basis - or bias - for individualised care.

Abstract

Background: An ageing population has increased the need for home-based palliative care. General practitioners (GPs) are central to continuity of care, yet time pressure and organisational constraints can challenge person-centred practice grounded in relational familiarity with patients and families.

Objectives: This study aims to explore how GPs navigate the relational familiarity in home-based palliative care and whether it functions as a basis or a bias for individualised care.

Design and methods: A secondary hermeneutic analysis was conducted, utilising data from two qualitative studies involving 21 GPs. These datasets focused on dignity-preserving care and shared decision making in palliative contexts. The hermeneutic circle was applied in an iterative process to interpret the in-depth interviews and focus group discussions.

Study design: A qualitative, explorative, and descriptive design grounded in hermeneutic methodology.

Results: Two overarching themes emerged: (1) Relational familiarity: A cornerstone of complex dimensions, where familiarity enabled trust, continuity and tailored care; however, it also created overfamiliarity that narrows perspective, blurs boundaries and burdens GPs. (2) Variability in engagement and follow-up, which reflected differences in individual GPs' interests, systemic constraints and the involvement of other healthcare professionals. While relational familiarity facilitated person-centred care, it was unevenly distributed, creating disparities in the quality of care.

Conclusion: Relational familiarity is key to person-centred palliative care, fostering trust and continuity. However, it can blur boundaries, create emotional strain and contribute to inequities compounded by systemic challenges. Interdisciplinary collaboration and flexible care models are needed to adapt to patient needs and ensure equitable access. Future research should examine the impact of relational familiarity and the role of systemic reforms to enhance palliative care.