Assing Hvidt Elisabeth, Søndergaard Jens, Ammentorp Jette, Bjerrum Lars, Gilså Hansen Dorte, Olesen Frede, Pedersen Susanne S, Timm Helle, Timmermann Connie, Hvidt Niels Christian
a Department of Public Health, Research Unit of General Practice, University of Southern Denmark , Odense C , Denmark.
b Health Services Research Unit, Lillebaelt Hospital, and Institute of Regional Health Services Research, University of Southern Denmark , Vejle , Denmark.
Scand J Prim Health Care. 2016 Dec;34(4):385-393. doi: 10.1080/02813432.2016.1249064. Epub 2016 Nov 2.
The objective of this study is to identify points of agreement and disagreements among general practitioners (GPs) in Denmark concerning how the existential dimension is understood, and when and how it is integrated in the GP-patient encounter.
A qualitative methodology with semi-structured focus group interviews was employed.
General practice setting in Denmark.
Thirty-one GPs from two Danish regions between 38 and 68 years of age participated in seven focus group interviews.
Although understood to involve broad life conditions such as present and future being and identity, connectedness to a society and to other people, the existential dimension was primarily reported integrated in connection with life-threatening diseases and death. Furthermore, integration of the existential dimension was characterized as unsystematic and intuitive. Communication about religious or spiritual questions was mostly avoided by GPs due to shyness and perceived lack of expertise. GPs also reported infrequent referrals of patients to chaplains.
GPs integrate issues related to the existential dimension in implicit and non-standardized ways and are hindered by cultural barriers. As a way to enhance a practice culture in which GPs pay more explicit attention to the patients' multidimensional concerns, opportunities for professional development could be offered (courses or seminars) that focus on mutual sharing of existential reflections, ideas and communication competencies. Key points Although integration of the existential dimension is recommended for patient care in general practice, little is known about GPs' understanding and integration of this dimension in the GP-patient encounter. The existential dimension is understood to involve broad and universal life conditions having no explicit reference to spiritual or religious aspects. The integration of the existential dimension is delimited to patient cases where life-threatening diseases, life crises and unexplainable patient symptoms occur. Integration of the existential dimension happens in unsystematic and intuitive ways. Cultural barriers such as shyness and lack of existential self-awareness seem to hinder GPs in communicating about issues related to the existential dimension. Educational initiatives might be needed in order to lessen barriers and enhance a more natural integration of communication about existential issues.
本研究的目的是确定丹麦全科医生（GP）在如何理解生存维度以及何时、如何将其融入医患会面方面的共识和分歧点。
采用半结构化焦点小组访谈的定性研究方法。
丹麦的全科医疗环境。
来自丹麦两个地区的31名年龄在38至68岁之间的全科医生参与了七次焦点小组访谈。
尽管生存维度被理解为涉及广泛的生活状况，如当下和未来的存在与身份、与社会及他人的联系，但主要报告显示其在与危及生命的疾病和死亡相关时被融入。此外，生存维度的融入具有非系统性和直观性的特点。由于害羞以及认为缺乏专业知识，全科医生大多避免就宗教或精神问题进行沟通。全科医生还报告称，很少将患者转介给牧师。
全科医生以隐性和非标准化的方式融入与生存维度相关的问题，且受到文化障碍的阻碍。作为增强一种实践文化的方式，在这种文化中全科医生能更明确地关注患者的多维度问题，可以提供专注于生存反思、想法和沟通能力相互分享的专业发展机会（课程或研讨会）。要点 尽管在全科医疗中为患者护理推荐融入生存维度，但对于全科医生在医患会面中对这一维度的理解和融入情况知之甚少。生存维度被理解为涉及广泛且普遍的生活状况，未明确提及精神或宗教方面。生存维度的融入局限于出现危及生命的疾病、生活危机和无法解释的患者症状的病例。生存维度的融入以非系统性和直观的方式发生。诸如害羞和缺乏生存自我意识等文化障碍似乎阻碍了全科医生就与生存维度相关的问题进行沟通。可能需要开展教育举措以减少障碍，并增强关于生存问题沟通的更自然融入。
