Mitchell Geoffrey K
Centre for General Practice, University of Queensland Medical School, Herston Road, Herston 4006, Queensland, Australia.
Palliat Med. 2002 Nov;16(6):457-64. doi: 10.1191/0269216302pm573oa.
General practitioners (GPs) deliver the majority of palliative care to patients in the last year of life. This article seeks to examine the nature of GP care, perceptions of the GPs themselves and others of that care, the adequacy of palliative care training, issues relating to accessibility of GPs to palliative care patients, and strategies that may be of use in encouraging more effective delivery of palliative care by GPs. Medline and PubMed databases from 1966 to 2000 were searched, and 135 references identified. Sixty-six of these described studies relevant to GP palliative care. GPs value this part of their work. Most of the time, patients appreciate the contribution the GP makes to palliative care particularly if the GP is accessible, takes time to listen, allows patient and carer to ventilate their feelings, and is seen to be making efforts made regarding symptom relief. However, reports from bereaved relatives suggest that palliative care is performed less well in the community than in other settings. GPs express discomfort about their competence to perform palliative care adequately. They tend to miss symptoms which are not treatable by them, or which are less common. However, with appropriate specialist support and facilities, GPs have been shown to deliver sound and effective care. GP comfort working with specialist teams increases with exposure to this form of patient management, as does the understanding of the potential other team members have in contributing to the care of the patient. Formal arrangements engaging GPs to work with specialist teams have been shown to improve functional outcomes, patient satisfaction, improve effective use of resources and improve effective physician behaviour in other areas of medicine. Efforts by specialist services to develop formal involvement of GPs in the care of individual patients, may be an effective method of improving GP palliative care skills and appreciation of the roles specialist services can play.
在患者生命的最后一年，全科医生（GP）为大多数患者提供姑息治疗。本文旨在探讨全科医生护理的性质、全科医生自身以及其他人员对该护理的看法、姑息治疗培训的充分性、全科医生接触姑息治疗患者的相关问题，以及可能有助于鼓励全科医生更有效地提供姑息治疗的策略。检索了1966年至2000年的Medline和PubMed数据库，共识别出135篇参考文献。其中66篇描述了与全科医生姑息治疗相关的研究。全科医生重视他们工作的这一部分。大多数时候，患者赞赏全科医生对姑息治疗所做的贡献，特别是如果全科医生容易接触到、愿意花时间倾听、允许患者和护理人员抒发情感，并且被认为在缓解症状方面做出了努力。然而，丧亲亲属的报告表明，社区中的姑息治疗不如其他环境中开展得好。全科医生对自己充分开展姑息治疗的能力表示不安。他们往往会遗漏那些他们无法治疗或不太常见的症状。然而，在适当的专科支持和设施下，全科医生已被证明能够提供合理且有效的护理。随着接触这种患者管理形式的增加，全科医生与专科团队合作时的舒适度会提高，对其他团队成员在患者护理中所做贡献的理解也会提高。已证明让全科医生与专科团队合作的正式安排可改善功能结局、提高患者满意度、改善资源的有效利用，并改善其他医学领域医生的有效行为。专科服务机构努力让全科医生正式参与个体患者的护理，可能是提高全科医生姑息治疗技能以及认识专科服务机构所能发挥作用的有效方法。
