Nowels David, Jones Jacqueline, Nowels Carolyn T, Matlock Daniel
From the Department of Family Medicine, University of Colorado School of Medicine, Aurora (DN); the University of Colorado College of Nursing (JJ); and the Department of Internal Medicine, Division of General Internal Medicine, University of Colorado School of Medicine (CTN, DM).
J Am Board Fam Med. 2016 Nov 12;29(6):748-758. doi: 10.3122/jabfm.2016.06.160054.
The need for all providers to deliver basic palliative care has emerged as patients' needs outstrip the capacity of specialty palliative care. Many patients with complex illnesses have unmet needs and are seen in primary care more than other settings. We explore primary care providers' willingness and perceived capacity to provide basic palliative care, and their concerns and perceived barriers.
We performed semistructured telephone interviews with 20 primary care providers about their perceptions of palliative care, including needs, practices, experiences, access, and what would be helpful for their practices to systematically provide basic palliative care.
We identified 3 major themes: (1) Participants recognize palliative needs in patients with complex problems. (2) They reactively respond to those needs using practice and community resources, believing that meeting those needs at a basic level is within the scope of primary care. (3) They can identify opportunities to improve the delivery of a basic palliative approach in primary care through practice change and redesign strategies used in enhanced primary care environments.
Systematic attention along the multidimensional domains of basic palliative care might allow practices to address unmet needs in patients with complex illnesses by using existing practice improvement models, strategies, and prioritization.
由于患者的需求超过了专科姑息治疗的能力，所有医疗服务提供者提供基本姑息治疗的需求应运而生。许多患有复杂疾病的患者存在未满足的需求，且在初级保健机构就诊的次数多于其他场所。我们探讨初级保健提供者提供基本姑息治疗的意愿和感知能力，以及他们的担忧和感知障碍。
我们对20名初级保健提供者进行了半结构化电话访谈，了解他们对姑息治疗的看法，包括需求、实践、经验、可及性，以及哪些因素有助于他们的机构系统地提供基本姑息治疗。
我们确定了3个主要主题：（1）参与者认识到患有复杂问题的患者的姑息治疗需求。（2）他们利用实践和社区资源对这些需求做出反应性回应，认为在基本层面满足这些需求属于初级保健的范畴。（3）他们能够通过在强化初级保健环境中使用的实践变革和重新设计策略，识别改善初级保健中基本姑息治疗方法提供的机会。
沿着基本姑息治疗的多维度领域进行系统关注，可能使医疗机构通过使用现有的实践改进模型、策略和优先级安排，满足患有复杂疾病患者未满足的需求。
