姑息治疗转介实践和观念：大都市和非大都市全科医生之间的分歧。
Palliative care referral practices and perceptions: the divide between metropolitan and non-metropolitan general practitioners.
机构信息
Centre for Health Research and Psycho-oncology, The Cancer Council NSW/University of Newcastle and Hunter Medical Research Institute, Newcastle, Australia.
Department of Palliative and Supportive Services, Flinders University, Adelaide, Australia.
出版信息
Palliat Support Care. 2011 Jun;9(2):181-9. doi: 10.1017/S1478951511000058.
OBJECTIVE
Late or non-referral of patients to specialist palliative care (SPC) services may affect patients' and their carers' quality of care. General practitioners (GPs) are key professionals in linking people with SPC. The aim of this article is to assess GPs' perceptions and SPC referrals for their patients with advanced cancer and differences between metropolitan (M GPs) and non-metropolitan GPs (NM GPs).
METHOD
Self-report survey mailed to a stratified random sample of 1,680 Australian GPs was used.
RESULTS
Thirty-one percent (469) of eligible GPs returned surveys. More M GPs than NM GPs reported referring >60% of their patients for SPC (p = 0.014); and that a more comprehensive range of SPC services was available. The most frequently reported referral prompts were: presence of terminal illness (M GPs, 71%, NM GPs, 66%, ns (not significant)); future need for symptom control (69% vs. 59%, ns) and uncontrolled physical symptoms (63% vs. 54%, ns). Reasons for not referring were: doctor's ability to manage symptoms (62% vs. 68%, ns) and the absence of symptoms (29% vs. 18%, p = 0.025). Higher referral was associated with: having a palliative care physician or consultative service available; agreeing that all patients with advanced cancer should be referred, and agreeing that with SPC, the needs of the family are better met.
SIGNIFICANCE OF RESULTS
Referrals for SPC were primarily disease-related rather than for psychological and emotional concerns. Measures are needed to encourage referrals based upon psychosocial needs as well as for physical concerns, and to support GPs caring for people with advanced cancer in areas with fewer comprehensive SPC services.
目的
患者向专科姑息治疗（SPC）服务机构的延迟或未转诊可能会影响患者及其护理人员的护理质量。全科医生（GP）是将患者与 SPC 联系起来的关键专业人员。本文旨在评估 GP 对晚期癌症患者的看法以及对 SPC 的转诊情况，同时比较大都市（M GP）和非大都市（NM GP）GP 之间的差异。
方法
使用分层随机抽样方法向 1680 名澳大利亚 GP 发送了一份自我报告调查问卷。
结果
符合条件的 469 名 GP 中有 31%（469 名）返回了调查。与 NM GP 相比，M GP 报告转诊超过 60%的患者接受 SPC 的比例更高（p = 0.014）；并且有更全面的 SPC 服务可供选择。最常报告的转诊提示是：存在终末期疾病（M GP，71%；NM GP，66%，无统计学意义）；未来对症状控制的需求（69% vs. 59%，无统计学意义）和未控制的身体症状（63% vs. 54%，无统计学意义）。不转诊的原因是：医生管理症状的能力（62% vs. 68%，无统计学意义）和没有症状（29% vs. 18%，p = 0.025）。更高的转诊率与以下因素相关：拥有姑息治疗医生或咨询服务；同意所有晚期癌症患者都应转诊，并且同意在 SPC 中，家庭的需求得到更好的满足。
意义
SPC 的转诊主要是基于疾病相关的因素，而不是基于心理和情绪方面的考虑。需要采取措施，鼓励根据心理社会需求以及身体方面的需求进行转诊，并为在 SPC 服务较不全面的地区照顾晚期癌症患者的 GP 提供支持。
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