Krug Katja, Ballhausen René Alexander, Bölter Regine, Engeser Peter, Wensing Michel, Szecsenyi Joachim, Peters-Klimm Frank
Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.
BMC Fam Pract. 2018 Jul 13;19(1):112. doi: 10.1186/s12875-018-0816-4.
Family caregivers (FCGs) of patients at the end of life (EoL) cared for at home receive support from professional and non-professional care providers. Healthcare providers in general practice play an important role as they coordinate care and establish contacts between the parties concerned. To identify potential intervention targets, this study deals with the challenges healthcare providers in general practice face in EoL care situations including patients, caregivers and networks.
Focus group discussions with general practice teams in Germany were conducted to identify barriers to and enablers of an optimal support for family caregivers. Focus group discussions were analysed using content analysis.
Nineteen providers from 11 general practices took part in 4 focus group discussions. Participants identified challenges in communication with patients, caregivers and within the professional network. Communication with patients and caregivers focused on non-verbal messages, communicating at an appropriate time and perceiving patient and caregiver as a unit of care. Practice teams perceive themselves as an important part of the healthcare network, but also report difficulties in communication and cooperation with other healthcare providers.
Healthcare providers in general practice identified relational challenges in daily primary palliative care with potential implications for EoL care. Communication and collaboration with patients, caregivers and among healthcare providers give opportunities for improving palliative care with a focus on the patient-caregiver dyad. It is insufficient to demand a (professional) support network; existing structures need to be recognized and included into the care.
在家中接受临终关怀的患者的家庭照顾者（FCG）会得到专业和非专业护理提供者的支持。全科医疗保健提供者发挥着重要作用，因为他们协调护理并在相关各方之间建立联系。为了确定潜在的干预目标，本研究探讨了全科医疗保健提供者在临终关怀情况下所面临的挑战，包括患者、照顾者和网络。
与德国的全科医疗团队进行焦点小组讨论，以确定对家庭照顾者提供最佳支持的障碍和促进因素。使用内容分析法对焦点小组讨论进行分析。
来自11家全科诊所的19名提供者参加了4次焦点小组讨论。参与者确定了在与患者、照顾者以及专业网络内部沟通方面的挑战。与患者和照顾者的沟通侧重于非语言信息、在适当时间进行沟通以及将患者和照顾者视为一个护理单元。诊所团队将自己视为医疗保健网络的重要组成部分，但也报告了在与其他医疗保健提供者沟通与合作方面的困难。
全科医疗保健提供者在日常初级姑息治疗中发现了关系方面的挑战，这可能对临终关怀产生影响。与患者、照顾者以及医疗保健提供者之间的沟通与协作提供了改善姑息治疗的机会，重点是患者 - 照顾者二元组。仅仅要求一个（专业）支持网络是不够的；需要认可现有的结构并将其纳入护理之中。
