Evans Natalie, Costantini Massimo, Pasman H R, Van den Block Lieve, Donker Gé A, Miccinesi Guido, Bertolissi Stefano, Gil Milagros, Boffin Nicole, Zurriaga Oscar, Deliens Luc, Onwuteaka-Philipsen Bregje
Department of Public and Occupational Health, EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands.
Regional Palliative Care Network, IRCCS AOU San Martino-IST, Genoa, Italy.
J Pain Symptom Manage. 2014 Mar;47(3):604-619.e3. doi: 10.1016/j.jpainsymman.2013.04.008. Epub 2013 Aug 7.
Effective communication is central to high-quality end-of-life care.
This study examined the prevalence of general practitioner (GP)-patient discussion of end-of-life topics (according to the GP) in Italy, Spain, Belgium, and The Netherlands and associated patient and care characteristics.
This cross-sectional, retrospective survey was conducted with representative GP networks. Using a standardized form, GPs recorded the health and care characteristics in the last three months of life, and the discussion of 10 end-of-life topics, of all patients who died under their care. The mean number of topics discussed, the prevalence of discussion of each topic, and patient and care characteristics associated with discussions were estimated per country.
In total, 4396 nonsudden deaths were included. On average, more topics were discussed in The Netherlands (mean=6.37), followed by Belgium (4.45), Spain (3.32), and Italy (3.19). The topics most frequently discussed in all countries were "physical complaints" and the "primary diagnosis," whereas "spiritual and existential issues" were the least frequently discussed. Discussions were most prevalent in The Netherlands, followed by Belgium. The GPs from all countries tended to discuss fewer topics with older patients, noncancer patients, patients with dementia, patients for whom palliative care was not an important treatment aim, and patients for whom their GP had not provided palliative care.
The prevalence of end-of-life discussions varied across the four countries. In all countries, training priorities should include the identification and discussion of spiritual and social problems and early end-of-life discussions with older patients, those with cognitive decline if possible, and those with non-malignant diseases.
有效的沟通是高质量临终关怀的核心。
本研究调查了意大利、西班牙、比利时和荷兰全科医生（GP）与患者讨论临终话题的普遍性（根据全科医生的报告）以及相关的患者和护理特征。
对具有代表性的全科医生网络进行了这项横断面回顾性调查。全科医生使用标准化表格记录了在其照料下死亡的所有患者生命最后三个月的健康和护理特征，以及10个临终话题的讨论情况。按国家估算了讨论话题的平均数量、每个话题的讨论普遍性以及与讨论相关的患者和护理特征。
总共纳入了4396例非猝死病例。平均而言，荷兰讨论的话题更多（平均=6.37），其次是比利时（4.45）、西班牙（3.32）和意大利（3.19）。所有国家最常讨论的话题是“身体不适”和“主要诊断”，而“精神和生存问题”讨论得最少。讨论在荷兰最为普遍，其次是比利时。所有国家的全科医生往往与老年患者、非癌症患者、痴呆患者、姑息治疗不是重要治疗目标的患者以及其全科医生未提供姑息治疗的患者讨论的话题较少。
四个国家临终讨论的普遍性各不相同。在所有国家，培训重点应包括识别和讨论精神和社会问题，以及与老年患者、可能有认知衰退的患者和患有非恶性疾病的患者尽早进行临终讨论。
