Keane Barry, Bellamy Gary, Gott Merryn
Regional Cancer Treatment Service, MidCentral Health, Palmerston North, New Zealand.
Faculty of Education and Health, University of Greenwich, Eltham, UK.
Health Soc Care Community. 2017 Jan;25(1):215-223. doi: 10.1111/hsc.12296. Epub 2015 Oct 26.
With the future focus on palliative and end-of-life care provision in the community, the role of the general practice team and their relationship with specialist palliative care providers is key to responding effectively to the projected increase in palliative care need. Studies have highlighted the potential to improve co-ordination and minimise fragmentation of care for people living with palliative care need through a partnership between generalist services and specialist palliative care. However, to date, the exact nature of this partnership approach has not been well defined and debate exists about how to make such partnerships work successfully. The aim of this study was to explore how general practice and specialist palliative care team (SPCT) members view their relationship in terms of partnership working. Five focus group discussions with general practices and SPCT members (n = 35) were conducted in 2012 in two different regions of New Zealand and analysed using a general inductive approach. The findings indicate that participants' understanding of partnership working was informed by their identity as a generalist or specialist, their existing rules of engagement and the approach they took towards sustaining the partnership. Considerable commitment to partnership working was shown by all participating teams. However, their working relationship was based primarily on trust and personal liaison, with limited formal systems in place to enable partnership working. Tensions between the cultures of 'generalism' and 'specialism' also provided challenges for those endeavouring to meet palliative care need collaboratively in the community. Further research is required to better understand the factors associated with successful partnership working between general practices and specialist palliative care in order to develop robust strategies to support a more sustainable model of community palliative care.
随着未来社区姑息治疗和临终关怀服务成为重点，全科医疗团队的作用及其与专科姑息治疗提供者的关系，对于有效应对预计增加的姑息治疗需求至关重要。研究强调，通过全科医疗服务与专科姑息治疗之间的合作关系，有潜力改善协调并减少姑息治疗需求者护理的碎片化。然而，迄今为止，这种合作方式的确切性质尚未明确界定，关于如何使此类合作成功开展也存在争议。本研究的目的是探讨全科医疗和专科姑息治疗团队（SPCT）成员如何看待他们在合作工作方面的关系。2012年在新西兰的两个不同地区，与全科医疗和SPCT成员（n = 35）进行了五次焦点小组讨论，并采用一般归纳法进行分析。研究结果表明，参与者对合作工作的理解受到其作为全科医生或专科医生的身份、现有的合作规则以及他们维持合作关系所采取的方法的影响。所有参与团队都对合作工作表现出了相当大的投入。然而，他们的工作关系主要基于信任和个人联系，用于支持合作工作的正式系统有限。 “全科”与“专科”文化之间的紧张关系，也给那些致力于在社区中共同满足姑息治疗需求者带来了挑战。需要进一步研究，以更好地理解与全科医疗和专科姑息治疗成功合作相关的因素，从而制定有力策略，以支持更可持续的社区姑息治疗模式。
