Reyniers Thijs, Houttekier Dirk, Pasman H Roeline, Stichele Robert Vander, Cohen Joachim, Deliens Luc
End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium.
Ann Fam Med. 2014 Sep-Oct;12(5):441-6. doi: 10.1370/afm.1666.
Family physicians play a pivotal role in providing end-of-life care and in enabling terminally ill patients to die in familiar surroundings. The purpose of this study was to explore the family physicians' perceptions of their role and the difficulties they have in preventing and guiding hospital admissions at the end of life.
Five focus groups were held with family physicians (N= 39) in Belgium. Discussions were transcribed verbatim and analyzed using a constant comparative approach.
Five key roles in preventing and guiding hospital admissions at the end of life were identified: as a care planner, anticipating future scenarios; as an initiator of decisions in acute situations, mostly in an advisory manner; as a provider of end-of-life care, in which competency and attitude is considered important; as a provider of support, particularly by being available during acute situations; and as a decision maker, taking overall responsibility.
Family physicians face many different and complex roles and difficulties in preventing and guiding hospital admissions at the end of life. Enhancing the family physician's role as a gatekeeper to hospital services, offering the physicians more end-of-life care training, and developing or expanding initiatives to support them could contribute to a lower proportion of hospital admissions at the end of life.
家庭医生在提供临终关怀以及使绝症患者在熟悉的环境中离世方面发挥着关键作用。本研究的目的是探讨家庭医生对其角色的认知以及他们在临终时预防和指导住院方面所面临的困难。
在比利时与家庭医生（N = 39）进行了五次焦点小组讨论。讨论内容逐字记录，并采用持续比较法进行分析。
确定了临终时预防和指导住院的五个关键角色：作为护理规划者，预测未来情况；作为急性情况下决策的发起者，主要以咨询方式；作为临终关怀提供者，其中能力和态度被认为很重要；作为支持提供者，特别是在急性情况下随时待命；以及作为决策者，承担全面责任。
家庭医生在临终时预防和指导住院方面面临许多不同且复杂的角色和困难。加强家庭医生作为医院服务守门人的角色，为医生提供更多临终关怀培训，并制定或扩大支持他们的举措，可能有助于降低临终时的住院比例。
