Palliative Care Department, Royal Gwent Hospital, Newport, UK.
Palliat Med. 2010 Jul;24(5):501-9. doi: 10.1177/0269216310368580. Epub 2010 May 25.
To date, the experiences of out-of-hours general practitioners with regard to palliative care patients and their management are yet to be evaluated, since the new General Medical Services contract came into force. In 2007 the National Institute for Health Research highlighted the need to identify factors that improve and hinder the delivery of optimum palliative out-of-hours care. By interviewing general practitioners who work out-of-hours shifts, this project explored factors influencing confidence in dealing with symptom control and palliative care provision outside regular working hours. Face-to-face semi-structured interviews were conducted with nine out-of-hours general practitioners employed by Serco. Interviews were conducted by a specialist doctor in palliative care who had in the past worked as an out-of-hours general practitioner. Interviews were analysed using Interpretative Phenomenological Analysis. General practitioners expressed concerns relating to constraints within the system provided by the private company-owned out-of-hours provider. Data from interviews was thematically very rich and brought out many different subject areas, some similar to previous interviews, some different. Sub-themes related to the process-driven aspects of working in out-of-hours: * Motivation, * Time-pressure constraints and continuity, * The out-of-hours doctor within the domain of palliative care, * Isolation within system. General practitioners stated that their motivation was mainly financial. There was clear concern about the lack of continuity, and inadequacy of notes and follow-up, and there was a demonstrated need for more learning on the topic of palliative care. Pressure from the out-of-hours provider to see more patients was felt to be oppositional with the need to spend adequate time with this vulnerable patient group. General practitioners felt as unwanted strangers who were viewed with suspicion by patients and carers in palliative care situations. It was clear that most of the doctors interviewed felt a strong sense of isolation when working out-of-hours shifts, and some felt less inclined to contact specialist palliative care services.
迄今为止，由于新的《全科医生服务合同》生效，还没有评估非工作时间全科医生在姑息治疗患者及其管理方面的经验。2007 年，国家卫生研究所强调需要确定改善和阻碍最佳姑息治疗非工作时间护理提供的因素。通过采访非工作时间轮班的全科医生，该项目探讨了影响他们在正常工作时间之外处理症状控制和姑息治疗信心的因素。与 Serco 签约的 9 名非工作时间全科医生进行了面对面的半结构化访谈。访谈由一位专门从事姑息治疗的医生进行，他曾担任过非工作时间的全科医生。使用解释现象学分析对访谈进行了分析。全科医生对私营公司所有的非工作时间服务提供商提供的系统限制表示担忧。访谈中的数据非常丰富，涉及到许多不同的主题领域，有些与之前的访谈相似，有些则不同。与非工作时间工作流程相关的主题包括：动机、时间压力限制和连续性、姑息治疗领域的非工作时间医生、系统内的孤立。全科医生表示，他们的动机主要是经济上的。他们明显担心连续性不足，记录和随访不足，并表现出对姑息治疗主题有更多的学习需求。非工作时间服务提供商的压力要求他们看更多的病人，这与他们需要与这个脆弱的病人群体充分相处的需求是对立的。全科医生觉得自己是不受欢迎的陌生人，在姑息治疗的情况下，会受到病人和护理者的怀疑。很明显，大多数接受采访的医生在非工作时间轮班时感到强烈的孤立感，一些人不太倾向于联系专业的姑息治疗服务。
