Palliative Care, Hospices Civils de Lyon, Lyon, France
Universite Lyon 1 Faculte de Medecine et de Maieutique Lyon-Sud Charles Merieux, Oullins, France.
BMJ Support Palliat Care. 2022 Dec;12(e6):e798-e802. doi: 10.1136/bmjspcare-2018-001714. Epub 2019 Feb 26.
Early palliative care leads to meaningful improvements in physical and psychosocial symptoms, as well as quality of life, in patients with advanced cancer. Patients with haematological malignancies, despite a high level of distress, continue to have less access to palliative care services. The aim of this study was to identify haematologists' perceptions of palliative care, as well as barriers to patient referral.
We used a qualitative grounded theory methodology. Twenty-four medical haematologists involved in clinical practice from two French centres in Lyon-the Lyon Sud University Hospital and the Léon Bérard Cancer Center-were included. The interview guide questions aimed to establish the clinical situations which triggered referral to palliative care and how participants perceived palliative care.
Data saturation was reached after 14 interviews. The data analysis highlighted four themes. The aim of palliative care was clearly identified as alleviating severe suffering. Palliative care was identified as a separate specialty, and respondents expressed the need for collaboration. Early intervention was perceived as beneficial to avoid certain situations such as hospitalisation or emergency department visits at the end of life. The main barrier to palliative care referral remained the negative connotations associated with the term 'palliative', which was overwhelmingly associated with the end of life.
Our results suggest that the principal barrier to palliative care referral is the term 'palliative care'; haematologists would prefer 'supportive care' instead.
早期姑息治疗可显著改善晚期癌症患者的身体和心理社会症状以及生活质量。尽管血液恶性肿瘤患者的痛苦程度较高，但他们获得姑息治疗服务的机会仍然较少。本研究旨在确定血液科医生对姑息治疗的看法，以及患者转介的障碍。
我们使用了定性扎根理论方法。纳入了来自法国里昂两个中心（里昂南大学医院和莱昂·贝拉德癌症中心）的 24 名参与临床实践的医学血液科医生。访谈指南中的问题旨在确定触发姑息治疗转介的临床情况以及参与者如何看待姑息治疗。
在 14 次访谈后达到了数据饱和。数据分析突出了四个主题。姑息治疗的目的显然是缓解严重的痛苦。姑息治疗被确定为一个单独的专业，受访者表示需要合作。早期干预被认为有益，可以避免某些情况，如临终时的住院或急诊就诊。姑息治疗转介的主要障碍仍然是与“姑息”一词相关的负面含义，该词与生命末期几乎完全相关。
我们的研究结果表明，姑息治疗转介的主要障碍是“姑息治疗”一词；血液科医生更愿意用“支持性治疗”来代替。
