Noble S I R, Nelson A, Finlay I G
Department of Palliative Medicine, Cardiff University and Royal Gwent Hospital, Wales.
Palliat Med. 2008 Jan;22(1):71-6. doi: 10.1177/0269216307084607.
It is possible that patients with advanced cancer, who are from the medical profession, have different or additional care needs than other patients. Previous training, professional experiences and access to information and services may influence their needs and subsequent illness behaviour. Caring for ;one of our own' may also evoke particular feelings and emotions from health professionals involved in their care and pose unique challenges in the delivery of equitable patient-centred care.
To explore the experiences of palliative care physicians when caring for members of the medical profession with advanced incurable cancer.
Semi-structured interviews exploring the experiences of senior palliative care physicians were recorded and transcribed verbatim. Transcripts were analysed using interpretative phenomenological analysis (IPA) for emergent themes. Data were collected from ten senior palliative care physicians with a combined total of 107 years of palliative care career experience, caring for a reported combined estimate of 120 doctor-patients.
On the basis of their reflections, palliative care physicians reported that doctor-patients appear to find it difficult to assume a patient role, especially at a time they are likely to be truly vulnerable. This patient group will routinely attempt to maintain control of their care and environment using various strategies. These include self-referrals, accessing their own tests, directing the consultation and putting barriers up to psychosocial aspects of palliative care. Doctor-patients' general practitioners are at risk of exclusion from the management of care, and referral to palliative care services appears to occur later in the illness journey of doctor-patients compared to lay patients. Participants recalled how caring for colleagues evokes powerful emotional responses, such as a strong desire to provide the best care possible as well as feelings of anxiety. They frequently find themselves under pressure to disclose confidential information from medical colleagues not involved in the doctor-patients' care. Doctor-patients frequently receive what other healthcare professionals perceive as preferential treatment, which may unintentionally result in suboptimal care.
The core needs of doctors with advanced cancer could be assumed to be the same as other patients. However, the juxtaposition of role from professional to patient appears to evoke unique care needs from the patient, and behaviour responses from the professional. Forewarning and awareness of these issues may help prevent potential problems in this patient group's cancer journey as well as the experience of the professionals involved in their management.
来自医疗行业的晚期癌症患者可能有不同于其他患者的护理需求或额外的护理需求。以前的培训、专业经验以及获取信息和服务的途径可能会影响他们的需求以及随后的患病行为。照顾“自己人”也可能会引发参与其护理的医护人员的特殊感受和情绪，并在提供公平的以患者为中心的护理方面带来独特的挑战。
探讨姑息治疗医生在照顾患有晚期不治之症的医疗行业成员时的经历。
对高级姑息治疗医生的经历进行的半结构化访谈被记录下来并逐字转录。使用解释性现象学分析（IPA）对转录本进行分析以找出新出现的主题。数据收集自十位高级姑息治疗医生，他们的姑息治疗职业生涯总经验为107年，据报道共照顾了约120名医生患者。
根据他们的反思，姑息治疗医生报告说，医生患者似乎很难承担患者角色，尤其是在他们可能真正脆弱的时候。这个患者群体通常会尝试使用各种策略来维持对其护理和环境的控制。这些策略包括自我转诊、进行自己的检查、主导会诊以及对姑息治疗的社会心理方面设置障碍。医生患者的全科医生有被排除在护理管理之外的风险，而且与非医生患者相比，医生患者转诊到姑息治疗服务的时间似乎在病程中更晚。参与者回忆起照顾同事是如何引发强烈的情绪反应的，比如强烈希望提供尽可能好的护理以及焦虑感。他们经常发现自己面临着向未参与医生患者护理的医学同事披露机密信息的压力。医生患者经常得到其他医护人员认为的优待，这可能无意中导致护理效果不佳。
晚期癌症医生的核心需求可能被认为与其他患者相同。然而，从专业人员到患者的角色转变似乎引发了患者独特的护理需求以及专业人员的行为反应。对这些问题的预先警示和认识可能有助于预防该患者群体在癌症病程中出现潜在问题，以及参与其管理的专业人员的体验。
