Taubert Mark, Noble Simon I R, Nelson Annmarie
Marie Curie Hospice Penarth, Penarth, South Glamorgan, UK.
BMJ Support Palliat Care. 2011 Jun;1(1):13-8. doi: 10.1136/bmjspcare-2011-000015. Epub 2011 Apr 21.
Not much is known about how general practitioners (GPs) who work regular out-of-hours shifts in the community feel about prescribing medication for symptom control in end-of-life care patients, how they gain palliative care experience and what they perceive as benefits and hindrances within service delivery to this vulnerable patient and carer group.
To determine, by interviewing GPs who provide out-of-hours care, aspects of care provision that augmented or challenged palliative care delivery.
Semistructured interviews were conducted with GPs who worked out-of-hours shifts regularly. All interviews were analysed using interpretative phenomenological analysis.
Out-of-hours doctors were not confident about their palliative care knowledge and expressed a wish for more education. Lack of familiarity with patients requiring acute palliative care, compared with the closer bonds formed within the in-hours general practice setting, was perceived as troublesome and problematic, and lack of follow-up was felt to be a major factor. There was a clearly expressed fear of killing or harming patients with the strong drugs used in palliative care. Opiophobia, especially when faced with patients who were seen only once, affected prescribing decisions.
This study provides further evidence of the needs of a specific subgroup of GPs. In-depth interview analysis of their experiences with palliative care provides a framework for which aspects are perceived as a hindrance in providing good palliative care, and can inform out-of-hours policy and teaching.
对于在社区定期值非工作时间班的全科医生（GP）在为临终关怀患者开具控制症状药物方面的感受、他们如何获得姑息治疗经验以及他们认为在为这个脆弱的患者和护理人员群体提供服务过程中的益处和障碍是什么，人们了解得并不多。
通过采访提供非工作时间护理的全科医生，确定增强或挑战姑息治疗服务的护理提供方面。
对定期值非工作时间班的全科医生进行半结构化访谈。所有访谈均采用解释性现象学分析进行分析。
非工作时间的医生对自己的姑息治疗知识缺乏信心，并表示希望接受更多教育。与在工作时间的全科医疗环境中形成的更紧密联系相比，对需要急性姑息治疗的患者缺乏熟悉感被认为是麻烦和有问题的，并且缺乏随访被认为是一个主要因素。对于在姑息治疗中使用强效药物导致患者死亡或受到伤害存在明显的恐惧。阿片恐惧症，尤其是在面对只见过一次的患者时，会影响处方决策。
本研究进一步证明了全科医生特定亚组的需求。对他们姑息治疗经历的深入访谈分析提供了一个框架，可据此了解哪些方面被视为提供良好姑息治疗的障碍，并可为非工作时间政策和教学提供参考。
