Katholieke Universiteit Leuven (LV), Leuven, Belgium.
Academic Centre for General Practice (BS, JL), Katholieke Universiteit Leuven, Leuven, Belgium.
Am J Geriatr Psychiatry. 2019 May;27(5):463-471. doi: 10.1016/j.jagp.2018.12.017. Epub 2018 Dec 18.
The goal of palliative care is to improve quality of life when recovery is no longer possible. The study's objective was to widen our vision of potential (unspoken) needs at the end of life with patients, close relatives, nurses, and general practitioners to aim at more versatile but personal care. The question asked was how important patients, close relatives, and healthcare providers considered the 11 core themes in defining a good death, as described in the 2016 article "Defining a good death" by Meier et al. METHODS: Specific questionnaires for general practitioners, nurses, patients, and family members were distributed in the working area of the regional palliative care network, Aalst-Dendermonde-Ninove, with the cooperation of five local quality groups, two nursing homes, and two groups of home care nurses, and data were analyzed.
Questionnaires were completed by 67 nurses, 57 general practitioners, 16 patients, and 8 family members. Although the 34 subthemes were generally considered important for classifying a death as a good one, there were still significant differences between general practitioners and nurses, men and women, and different age groups. Nurses found 9 of the 34 themes significantly more important than general practitioners. All groups believed a pain-free death was most important. General practitioners, nurses, patients, and close relatives found the following themes important: support of family, respect for patient as an individual, being able to say goodbye, and euthanasia in case of unbearable suffering.
In agreement with the patient, medical care should focus on a pain-free situation during the last phase of life and not on exhausting possible treatments to prolong life unnecessarily. Appropriate care at the end of life can be broader, and all 34 subthemes can be important in early healthcare planning. Significant differences between general practitioners and nurses deserve attention because patients and family members expect that healthcare providers will work together as a team.
姑息治疗的目的是在无法康复的情况下提高生活质量。本研究的目的是拓宽我们对患者、近亲、护士和全科医生临终时潜在(未言明)需求的视野,以实现更具通用性但更具个性的护理。提出的问题是,患者、近亲以及医疗保健提供者如何看待 2016 年 Meier 等人发表的文章“定义美好死亡”中描述的 11 个核心主题对于定义美好死亡的重要性。
在区域姑息治疗网络 Aalst-Dendermonde-Ninove 的工作区域内,与五个当地质量小组、两个疗养院和两个家庭护理护士小组合作,分发了针对全科医生、护士、患者和家庭成员的特定问卷,并对数据进行了分析。
67 名护士、57 名全科医生、16 名患者和 8 名家属填写了问卷。尽管 34 个次主题通常被认为对将死亡归类为美好死亡很重要,但全科医生和护士、男性和女性以及不同年龄组之间仍存在显著差异。护士认为 34 个主题中的 9 个比全科医生更重要。所有组都认为无痛死亡最重要。全科医生、护士、患者和近亲认为以下主题很重要:家庭支持、尊重患者作为个体、能够道别以及在无法忍受的痛苦情况下实施安乐死。
与患者一致,医疗保健应关注生命最后阶段的无痛状况,而不是不必要地用尽可能的治疗方法来延长生命。适当的临终关怀可以更加广泛,所有 34 个次主题在早期医疗保健规划中都可能很重要。全科医生和护士之间的显著差异值得关注,因为患者和家属期望医疗保健提供者能够作为一个团队共同协作。