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One interviewee started out recording with permission, but after "being threatened with removal from the practice" (interviewee 8) began to record covertly.
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In practice, however, interviewees often found it difficult to be this assertive.
(district nurse 7, practice D) Interviewees varied widely in how they felt about initiating the discussion themselves.
There is just no continuity.' – Network Director At the general practice level, interviewees reported a diversity of practice cultures that demanded flexibility in approaches to engagement.
(general practitioner 6, practice C) Interviewees varied in the extent to which they saw themselves as involved in discussions about preferred place of death in comparison with other members of the team.
Many different, socially recognised forms of liaison may operate in any given context for example a traditional practice which interviewees reported to contribute to the spread of HIV known as nyumba ntobu (literary means female to female marriages) which is common in Serengeti district and particularly among one ethnic group (name withheld).
Despite these quite different responses to some of the practices, the interviewees didn't feel that any specific exercises should be left out of the program.
We also accepted either the GP or the nurse working in that practice as the interviewee, and so it is reasonable to conclude that the links may have been reported differently depending on who was interviewed.
(general practitioner 15, practice J) Some interviewees identified a particular situation where it was difficult to assert whether the patient died at their preferred place or not.
Or, in the middle when they haven't got consciousness so they can't make a decision?" (district nurse 8, practice E) Some interviewees were also apprehensive about potential deviations from good practice.
(district nurse 7, practice D) Most interviewees could recall patients with whom they had found it extremely difficult or impossible, unethical, or potentially damaging to the doctor-patient relationship to discuss preferred place of death.
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