Ewing Gail, Farquhar Morag, Booth Sara
Centre for Family Research, University of Cambridge, Cambridge, UK.
J Pain Symptom Manage. 2009 Sep;38(3):327-40. doi: 10.1016/j.jpainsymman.2008.09.009. Epub 2009 Jun 25.
There has been a steady expansion of hospital-based palliative care in the United Kingdom but limited published research on health professionals' views of hospital multidisciplinary specialist palliative care services (SPCS). The aim of the study was to describe referrer (SPCS user) and provider (SPCS staff) perspectives on delivery of specialist palliative care in hospital. Interviews were conducted with referrers, including five junior doctors, 13 consultants, and six clinical nurse specialists, to investigate the reasons for referral, beneficial aspects, and barriers to use. Focus groups were conducted with providers, six medical and five nursing, to identify their perspective on delivering the specialist service in hospital. Discussions were tape recorded and transcribed verbatim. Data were analyzed thematically using a framework analysis approach. The study found large areas of agreement between referrers and providers on what hospital palliative care teams should be providing for patients, that is, expertise in managing difficult symptoms and complex psychosocial problems, and this was being achieved locally. Access to the specialist team was also important: visibility on the wards, informal routes of access to advice and a timely response by specialists. However, discordance in views of providing palliative care was also identified; in particular, whether specialists should be providing generalist palliative care (such as basic psychological support) neglected by ward teams and implementation of specialist advice by referrers. Such perspectives on the interface of generalist and specialist provision provide insights into improving care for palliative patients in the acute hospital setting.
英国以医院为基础的姑息治疗一直在稳步扩展，但关于卫生专业人员对医院多学科专科姑息治疗服务（SPCS）看法的已发表研究有限。本研究的目的是描述转诊者（SPCS使用者）和提供者（SPCS工作人员）对医院专科姑息治疗提供情况的看法。对转诊者进行了访谈，包括5名初级医生、13名顾问和6名临床护士专家，以调查转诊原因、有益方面和使用障碍。对提供者进行了焦点小组讨论，包括6名医生和5名护士，以确定他们对在医院提供专科服务的看法。讨论进行了录音并逐字转录。使用框架分析方法对数据进行了主题分析。研究发现，转诊者和提供者在医院姑息治疗团队应为患者提供什么方面存在很大程度的共识，即管理疑难症状和复杂心理社会问题的专业知识，并且这在当地正在实现。获得专科团队的服务也很重要：在病房中容易见到、获得建议的非正式途径以及专家的及时回应。然而，在提供姑息治疗的观点上也发现了不一致之处；特别是，专家是否应提供病房团队忽视的全科姑息治疗（如基本心理支持）以及转诊者对专家建议的实施情况。这种关于全科和专科服务衔接的观点为改善急症医院环境中姑息治疗患者的护理提供了见解。
