Mitchell Geoffrey K, Senior Hugh E, Johnson Claire E, Fallon-Ferguson Julia, Williams Briony, Monterosso Leanne, Rhee Joel J, McVey Peta, Grant Matthew P, Aubin Michèle, Nwachukwu Harriet Tg, Yates Patsy M
Primary Care Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Australia.
College of Health, Massey University, Auckland, New Zealand.
BMJ Support Palliat Care. 2018 Dec;8(4):411-420. doi: 10.1136/bmjspcare-2017-001374. Epub 2018 Jan 20.
End of life care (EoLC) is a fundamental role of general practice, which will become more important as the population ages. It is essential that general practice's role and performance of at the end of life is understood in order to maximise the skills of the entire workforce.
To provide a comprehensive description of the role and performance of general practitioners (GPs) and general practice nurses (GPNs) in EoLC symptom control.
Systematic literature review of papers from 2000 to 2017 were sought from Medline, PsycINFO, Embase, Joanna Briggs Institute and Cochrane databases.
From 6209 journal articles, 46 papers reported GP performance in symptom management. There was no reference to the performance of GPNs in any paper identified. Most GPs expressed confidence in identifying EoLC symptoms. However, they reported lack of confidence in providing EoLC at the beginning of their careers, and improvements with time in practice. They perceived emotional support as being the most important aspect of EoLC that they provide, but there were barriers to its provision. GPs felt most comfortable treating pain, and least confident with dyspnoea and depression. Observed pain management was sometimes not optimal. More formal training, particularly in the use of opioids was considered important to improve management of both pain and dyspnoea.
It is essential that GPs receive regular education and training, and exposure to EoLC from an early stage in their careers to ensure skill and confidence. Research into the role of GPNs in symptom control needs to occur.
临终关怀是全科医疗的一项基本职责，随着人口老龄化，其重要性将日益凸显。了解全科医疗在临终阶段的作用和表现，对于充分发挥整个医疗团队的技能至关重要。
全面描述全科医生（GP）和全科护士（GPN）在临终关怀症状控制方面的作用和表现。
从Medline、PsycINFO、Embase、乔安娜·布里格斯研究所和考科蓝数据库中检索2000年至2017年的相关论文进行系统文献综述。
从6209篇期刊文章中，46篇报道了全科医生在症状管理方面的表现。在所检索到的任何论文中均未提及全科护士的表现。大多数全科医生对识别临终关怀症状表示有信心。然而，他们表示在职业生涯初期对提供临终关怀缺乏信心，随着实践经验的积累，信心有所提高。他们认为情感支持是他们提供临终关怀中最重要的方面，但在提供情感支持方面存在障碍。全科医生在治疗疼痛时感觉最得心应手，而对呼吸困难和抑郁的治疗最缺乏信心。观察到的疼痛管理有时并不理想。他们认为更正规的培训，尤其是阿片类药物的使用培训，对于改善疼痛和呼吸困难的管理很重要。
全科医生必须在职业生涯早期接受定期教育和培训，并接触临终关怀，以确保技能和信心。需要对全科护士在症状控制方面的作用进行研究。
