Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, The Netherlands.
Ann Fam Med. 2012 Jul-Aug;10(4):330-6. doi: 10.1370/afm.1373.
Depression is highly prevalent in palliative care patients. In clinical practice, there is concern about both insufficient and excessive diagnosis and treatment of depression. In the Netherlands, family physicians have a central role in delivering palliative care. We explored variation in family physicians' opinions regarding the recognition, diagnosis, and management of depression in palliative care patients.
We conducted a focus group study in a sample of family physicians with varied practice locations and varying expertise in palliative care. Transcripts were analyzed independently by 2 researchers using constant comparative analysis in ATLAS.ti.
In 4 focus group discussions with 22 family physicians, the physicians described the diagnostic and therapeutic process for depression in palliative care patients as a continuous and overlapping process. Differentiating between normal and abnormal sadness was viewed as challenging. The physicians did not strictly apply criteria of depressive disorder but rather relied on their clinical judgment and strongly considered patients' context and background factors. They indicated that managing depression in palliative care patients is mainly supportive and nonspecific. Antidepressant drugs were seldom prescribed. The physicians described difficulties in diagnosing and treating depression in palliative care, and gave suggestions to improve management of depression in palliative care patients in primary care.
Family physicians perceive the diagnosis and management of depression in palliative care patients as challenging. They rely on open communication and a long-standing physician-patient relationship in which the patient's context is of great importance. This approach fits with the patient-centered care that is promoted in primary care.
在姑息治疗患者中，抑郁症的发病率很高。在临床实践中，人们担心对抑郁症的诊断和治疗不足或过度。在荷兰，家庭医生在提供姑息治疗方面发挥着核心作用。我们探讨了家庭医生在姑息治疗患者中识别、诊断和管理抑郁症方面的意见差异。
我们对来自不同实践地点和姑息治疗专业水平的家庭医生样本进行了焦点小组研究。两位研究人员使用 ATLAS.ti 中的恒定性比较分析方法对 22 位家庭医生的 4 次焦点小组讨论记录进行了独立分析。
在 4 次焦点小组讨论中，共有 22 位家庭医生参与，医生们将姑息治疗患者中抑郁症的诊断和治疗过程描述为一个连续和重叠的过程。区分正常悲伤和异常悲伤被认为具有挑战性。医生们并没有严格应用抑郁障碍的标准，而是依赖于他们的临床判断，并非常考虑患者的背景因素。他们表示，姑息治疗患者的抑郁症主要是支持性和非特异性的治疗。很少开抗抑郁药。医生们描述了在姑息治疗中诊断和治疗抑郁症的困难，并提出了改善初级保健中姑息治疗患者抑郁症管理的建议。
家庭医生认为姑息治疗患者的抑郁症诊断和治疗具有挑战性。他们依赖于开放的沟通和长期的医患关系，其中患者的背景非常重要。这种方法符合在初级保健中倡导的以患者为中心的护理。
