Witham Gary, Haigh Carol, Foy Sharon
Department of Nursing, Manchester Metropolitan University, Manchester, UK.
J Clin Nurs. 2014 Oct;23(19-20):2844-53. doi: 10.1111/jocn.12583. Epub 2014 Mar 20.
To explore health professionals' perceptions of the needs of patients undergoing chemotherapy treatment for cancer.
Patients with vulnerabilities face additional challenges. People with learning difficulties are often protected from even basic cancer information; patients with severe mental illness are open to structural discrimination with limited access to diagnostic and treatment services. There is also a much poorer survival rate after a cancer diagnosis for patients living with dementia.
A qualitative design was used.
A focus group design was undertaken for this project using a narrative analytical approach revealing how narrative tales are presented and performed. Eighteen healthcare workers were recruited from a regional oncology centre in North West England. Two focus groups were conducted with nine participants in each. The data were collected from late 2011-2012.
Participants were primarily focused on getting patients through treatment. The identification of vulnerability was an 'extra' complication and one that in practice was difficult to define/categorise. The participants appreciated the wider inclusion of family and friends to support vulnerable patients although they felt formalised health care was not particularly facilitative of this process. There were difficulties in achieving support for complex patient needs in the presence of a target driven culture.
Healthcare professionals need wider managerial and cultural support in meeting the needs of vulnerable patients. There appeared to be a tendency by healthcare professionals to minimise the inherent coping abilities of vulnerable patients.
There is a clear need to support health professionals in providing appropriate resources in order to address the complex needs of vulnerable patients. This requires a cultural shift away from targets and an investment into greater resources for effective multidisciplinary working.
探讨医疗保健专业人员对癌症化疗患者需求的看法。
弱势群体患者面临更多挑战。有学习困难的人往往甚至无法获得基本的癌症信息；患有严重精神疾病的患者容易受到结构性歧视，获得诊断和治疗服务的机会有限。痴呆症患者在癌症诊断后的生存率也低得多。
采用定性设计。
本项目采用焦点小组设计，运用叙事分析方法揭示叙事故事是如何呈现和展开的。从英格兰西北部的一个地区肿瘤中心招募了18名医护人员。进行了两个焦点小组，每组有9名参与者。数据收集于2011年末至2012年。
参与者主要关注让患者完成治疗。确定脆弱性是一个“额外”的复杂情况，在实践中很难定义/分类。参与者赞赏更广泛地纳入家人和朋友来支持脆弱患者，尽管他们觉得正规医疗保健对这一过程并没有特别的促进作用。在目标驱动的文化背景下，满足复杂患者需求时存在困难。
医疗保健专业人员在满足脆弱患者需求方面需要更广泛的管理和文化支持。医疗保健专业人员似乎有一种倾向，即尽量减少脆弱患者的内在应对能力。
显然需要支持医疗保健专业人员提供适当资源，以满足脆弱患者的复杂需求。这需要从以目标为导向的文化转变，投入更多资源以实现有效的多学科协作。
