Wind Jan, Nugteren Ineke C, van Laarhoven Hanneke W M, van Weert Henk C P M, Henselmans Inge
a Department of General Practice, Academic Medical Centre Amsterdam , University of Amsterdam , Amsterdam , the Netherlands.
b Department of Medical Oncology, Academic Medical Centre Amsterdam , University of Amsterdam , Amsterdam , the Netherlands.
Scand J Prim Health Care. 2018 Dec;36(4):437-445. doi: 10.1080/02813432.2018.1535264. Epub 2018 Oct 30.
While close collaboration between general practitioners (GPs) and hospital specialists is considered important, the sharing of care responsibilities between GPs and oncologists during palliative chemotherapy has not been clearly defined.
Evaluate the opinions of GPs and oncologists about who should provide different aspects of care for patients receiving palliative chemotherapy.
We conducted semi-structured interviews using six hypothetical scenarios with purposively sampled GPs (n = 12) and oncologists (n = 10) in the Netherlands. Each represented an example of a clinical problem requiring different aspects of care: problems likely, or not, related to cancer or chemotherapy, need for decision support, and end-of-life care.
GPs and oncologists agreed that GPs should provide end-of-life care and that they should be involved in decisions about palliative chemotherapy; however, for the other scenarios most participants considered themselves the most appropriate provider of care. Themes that emerged regarding who would provide the best care for the patients in the different scenarios were expertise, continuity of care, accessibility of care, doctor-patient relationship, and communication. Most participants mentioned improved communication between the GP and oncologist as being essential for a better coordination and quality of care.
GPs and oncologists have different opinions about who should ideally provide different aspects of care during palliative chemotherapy. Findings raise awareness of the differences in reasoning and approaches and in current communication deficits between the two groups of health professionals. These findings could be used to improve coordination and collaboration and, ultimately, better patient care as results demonstrated that both disciplines can add value to the care for patients with advanced cancer. Key points This study identified contrasting opinions of GPs and oncologists about who should provide different aspects of care for patients receiving palliative chemotherapy. Important themes that emerged were expertise, continuity of care, doctor-patient relations, accessibility of care, and communication. Although frequently using the same arguments, GPs and oncologists often considered themselves to be the most appropriate providers of palliative care.
虽然全科医生（GP）与医院专科医生之间的密切合作被认为很重要，但在姑息性化疗期间全科医生与肿瘤学家之间护理责任的分担尚未明确界定。
评估全科医生和肿瘤学家对于应由谁为接受姑息性化疗的患者提供不同方面护理的看法。
我们在荷兰对经过有目的抽样的12名全科医生和10名肿瘤学家进行了半结构化访谈，使用了六个假设情景。每个情景代表一个需要不同方面护理的临床问题示例：可能与癌症或化疗相关或不相关的问题、决策支持需求以及临终护理。
全科医生和肿瘤学家一致认为全科医生应提供临终护理，并且应参与关于姑息性化疗的决策；然而，对于其他情景，大多数参与者认为自己是最合适的护理提供者。在不同情景中，关于谁将为患者提供最佳护理出现的主题包括专业知识、护理连续性、护理可及性、医患关系和沟通。大多数参与者提到全科医生与肿瘤学家之间改善沟通对于更好地协调护理和提高护理质量至关重要。
全科医生和肿瘤学家对于在姑息性化疗期间理想情况下应由谁提供不同方面的护理存在不同意见。研究结果提高了对两组卫生专业人员在推理和方法以及当前沟通缺陷方面差异的认识。这些发现可用于改善协调与合作，并最终提供更好的患者护理，因为结果表明这两个学科都可为晚期癌症患者的护理增添价值。关键点 本研究确定了全科医生和肿瘤学家对于应由谁为接受姑息性化疗的患者提供不同方面护理的不同意见。出现的重要主题包括专业知识、护理连续性、医患关系、护理可及性和沟通。尽管经常使用相同的论据，但全科医生和肿瘤学家通常认为自己是最合适的姑息治疗提供者。
