McGorty E Kiernan, Bornstein Brian H
Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE 68588-0308, USA.
J Eval Clin Pract. 2003 Aug;9(3):363-72. doi: 10.1046/j.1365-2753.2003.00406.x.
Due to its comprehensive and cost-saving design, hospice has become a critical component of health care. Physicians have become the primary gatekeepers to information on hospice and sources of referral to hospice. However, many physicians do not discuss hospice options until late in the disease course, when patients and their families are no longer able to benefit from hospice services. Although physicians, as well as patients and hospice personnel, cite patient and hospice structure factors as barriers, the present article will focus on barriers physicians have more control over, such as their discomfort discussing terminality and fear of losing contact with patients. Focusing on the American hospice model, the present article will review past findings, examine gaps in the research, and propose systematic ways to discern whether the factors physicians claim are barriers actually affect their decision making about hospice referral.
由于其全面且节省成本的设计，临终关怀已成为医疗保健的关键组成部分。医生已成为临终关怀信息及临终关怀转诊来源的主要把关人。然而，许多医生直到疾病晚期才讨论临终关怀选项，此时患者及其家属已无法从临终关怀服务中受益。尽管医生以及患者和临终关怀工作人员都将患者和临终关怀机构的结构因素视为障碍，但本文将重点关注医生更能掌控的障碍，比如他们在讨论临终状态时的不适感以及对与患者失去联系的恐惧。以美国临终关怀模式为重点，本文将回顾过去的研究结果，审视研究中的差距，并提出系统的方法来辨别医生声称的障碍因素是否真的影响他们关于临终关怀转诊的决策。
