Pressure in dealing with requests for euthanasia or assisted suicide. Experiences of general practitioners.

The majority of Dutch physicians feel pressure when dealing with a request for euthanasia or physician-assisted suicide (EAS). This study aimed to explore the content of this pressure as experienced by general practitioners (GP). We conducted semistructured in-depth interviews with 15 Dutch GPs, focusing on actual cases. The interviews were transcribed and analysed with use of the framework method. Six categories of pressure GPs experienced in dealing with EAS requests were revealed: (1) emotional blackmail, (2) control and direction by others, (3) doubts about fulfilling the criteria, (4) counterpressure by patient's relatives, (5) time pressure around referred patients and (6) organisational pressure. We conclude that the pressure can be attributable to the patient-physician relationship and/or the relationship between the physician and the patient's relative(s), the inherent complexity of the decision itself and the circumstances under which the decision has to be made. To prevent physicians to cross their personal boundaries in dealing with EAS request all these different sources of pressure will have to be taken into account.

Professionals' perceptions of factors affecting implementation and continuation of a physical activity promotion programme in rehabilitation: A qualitative study.

OBJECTIVE: To describe professionals' perceptions of factors that facilitate or hamper the implementation and continuation of a physical activity promotion programme in rehabilitation. DESIGN: This study used a qualitative design. METHODS: Semi-structured interviews (n = 22) were conducted with rehabilitation professionals (n = 28) involved in the implementation of a physical activity promotion programme. Two additional interviews were conducted with the programme coordinators (n = 2). The study involved 18 rehabilitation organizations implementing the programme that targets people with disabilities or chronic diseases. Organizations were supported in the implementation process by the programme coordinators. RESULTS: Commonly perceived facilitating factors were: involvement of committed and enthusiastic professionals; agreement with their organizations' vision/wishes; the perceived additional value of the programme; and opportunities to share knowledge and experience with professionals from other organizations. Commonly perceived hampering factors were: uncertainty about continuing the programme; limited flexibility; and lack of support from physicians and therapists to implement the programme. CONCLUSION: Professionals perceived a heterogeneous set of factors that facilitate and/or hamper the implementation and continuation of a physical activity promotion programme in rehabilitation. Based on these findings, recommendations were formulated to enhance embedding of physical activity promotion during and after rehabilitation.