Shearer Freya M, Rogers Ian R, Monterosso Leanne, Ross-Adjie Gail, Rogers Jeremy R
Emergency Department, St John of God Murdoch Hospital, Murdoch, Western Australia, Australia.
Emerg Med Australas. 2014 Jun;26(3):249-55. doi: 10.1111/1742-6723.12215. Epub 2014 Apr 8.
The primary aim of the present study was to investigate Australian ED staff perspectives and needs regarding palliative care provision. Secondary aims were to assess staff views about death and dying, and their awareness of common causes of death in Australia, particularly those where a palliative care approach is appropriate.
All medical and nursing staff working in a private ED in Perth, Western Australia, were asked to complete a combined quantitative and qualitative survey. The survey tool uses a combination of Likert-type scales and open-ended questions. Descriptive statistics and intergroup comparisons were made for all quantifiable variables, whereas formal content analysis was used for text responses.
Surveys were returned by 22 doctors and 44 nurses, with most reporting only working knowledge of palliative care but clinical proficiency in symptom control. Confidence in palliative care provision was lower among nursing than medical staff but educational needs were similar. Cancer diagnoses were consistently overestimated, and dementia and COPD underestimated, as the most common causes of death. Only six of 63 (9.5%) of respondents identified the correct top five causes of death.
Our study suggests that although ED staff expressed confidence regarding symptom management in palliative care, they lacked understanding of the patients in whom a palliative approach could be applied and sought further education in areas, such as end-of-life communication and ethical issues. ED specific training and clinical interventions in palliative care provision would seem to be needed and justified.
本研究的主要目的是调查澳大利亚急诊科工作人员在提供姑息治疗方面的观点和需求。次要目的是评估工作人员对死亡和临终的看法，以及他们对澳大利亚常见死因的认识，特别是那些适合采用姑息治疗方法的死因。
要求在西澳大利亚州珀斯一家私立急诊科工作的所有医护人员完成一项定量与定性相结合的调查。调查工具采用李克特量表和开放式问题相结合的方式。对所有可量化变量进行描述性统计和组间比较，而对文本回复采用正式的内容分析。
22名医生和44名护士返回了调查问卷，大多数人报告仅具备姑息治疗的工作知识，但在症状控制方面具备临床熟练程度。护理人员在提供姑息治疗方面的信心低于医务人员，但教育需求相似。癌症诊断一直被高估，而痴呆症和慢性阻塞性肺病作为最常见死因被低估。63名受访者中只有6人（9.5%）正确识别了前五大死因。
我们的研究表明，尽管急诊科工作人员对姑息治疗中的症状管理表示有信心，但他们对可应用姑息治疗方法的患者缺乏了解，并在诸如临终沟通和伦理问题等领域寻求进一步教育。似乎需要并合理进行针对急诊科的姑息治疗培训和临床干预。
