Wright Bethany, Forbes Karen
St Peter's Hospice, Bristol, UK.
University of Bristol and University Hospitals Bristol NHS Trust, Bristol, UK.
BMJ Support Palliat Care. 2017 Mar;7(1):39-45. doi: 10.1136/bmjspcare-2014-000689. Epub 2014 Sep 24.
This study explored the views and perceptions of haematologists towards palliative care, based on their own clinical experiences, focusing on those factors that helped or hindered referral to specialist palliative care (SPC) services.
We conducted in-depth face-to-face interviews with a purposive sample of eight trainee and consultant haematologists working in tertiary referral centres in the West Midlands. All interviews were recorded, transcribed and subsequently analysed using the principles of the grounded theory approach.
Data analysis revealed a core category around boundaries alongside four emerging categories: perceptions of palliative care; philosophy of approach; determining roles; and responsibility and control. Positive attitudes towards SPC involvement were expressed by most participants. The role of SPC services was sometimes difficult for participants to define, with timing of referral often determined by their level of confidence in providing end-of-life care. Almost all highlighted a lack of inpatient palliative care unit provision; this was viewed negatively and impacted on referral.
While positive attitudes towards palliative care were expressed, barriers to collaboration between haematology and SPC services were identified and provided opportunities for improved interdisciplinary working. Suggestions for improvement are focused around: improved training; enhanced mutual respect and understanding; clearer definition of the role of SPC services; and consistency and flexibility in service provision.
本研究基于血液科医生自身的临床经验，探讨他们对姑息治疗的看法和认知，重点关注那些有助于或阻碍转诊至专科姑息治疗（SPC）服务的因素。
我们对西米德兰兹地区三级转诊中心的8名实习血液科医生和顾问血液科医生进行了有目的抽样的深入面对面访谈。所有访谈均进行了录音、转录，并随后采用扎根理论方法的原则进行分析。
数据分析揭示了一个围绕界限的核心类别以及四个新出现的类别：对姑息治疗的认知；治疗方法理念；确定角色；以及责任与控制。大多数参与者对SPC的参与表达了积极态度。参与者有时难以界定SPC服务的作用，转诊时机往往取决于他们对提供临终关怀的信心程度。几乎所有人都强调缺乏住院姑息治疗病房；这被视为负面因素并影响了转诊。
虽然对姑息治疗表达了积极态度，但确定了血液科与SPC服务之间合作的障碍，并为改善跨学科合作提供了机会。改进建议集中在：改进培训；增强相互尊重和理解；更明确地界定SPC服务的作用；以及服务提供的一致性和灵活性。
