在一般姑息治疗中谈论临终 - 怎么回事？丹麦一家急性护理医院关于临终谈话的定性研究。
Talking about end of life in general palliative care - what's going on? A qualitative study on end-of-life conversations in an acute care hospital in Denmark.
机构信息
Holbaek Hospital, Smedelundsgade 60, 4300, Holbæk, Region Zealand, Denmark.
REHPA, Knowledge Centre for Rehabilitation and Palliative Care, National Institute of Public Health, University of Southern Denmark, Vestergade 17, 5800, Nyborg, Denmark.
出版信息
BMC Palliat Care. 2019 Jul 25;18(1):62. doi: 10.1186/s12904-019-0448-z.
BACKGROUND
End-of-life (EOL) conversations in hospital should serve to give patients the opportunity to consider future treatment options and help them clarify their values and wishes before it becomes relevant to make decisions about treatment. However, it is known that EOL conversations are not performed systematically in hospital. This may mean that patients and their relatives do not address EOL issues. There is a lack of knowledge about who is responsible for conducting these conversations, and when and under what circumstances they are conducted. The aim of this study was to explore the existing practices regarding EOL conversations in an acute care hospital setting.
METHODS
The design was Interpretive Description and the methods for the data collection included: 1. Participatory observational studies in a pulmonary medical and surgical ward (a total of 66 h); 2. Four focus group interviews with healthcare professionals (n = 14) from the wards. The analysis followed Spradley's ethnosemantic analysis.
RESULTS
The results revealed three cultural categories related to: 1. The physical and organizational setting; 2. The timing of EOL conversations and competencies and roles in addressing EOL issues and 3. Topics addressed in EOL conversations. The EOL conversations were part of daily clinical practice, but there was a lack of competencies, roles were unclear and the physical and organizational environment was not conducive to the conversations. The topics of the EOL conversations revolved around a "here-and-now" status of the patient's disease progression and decisions about the level of treatment. To a lesser extent, the conversations included the patient's and relatives' thoughts and wishes concerning EOL, which allowed long-term care planning.
CONCLUSION
This study demonstrates that there are several barriers to talking about EOL in an acute care hospital setting, and future strategies must address an overall approach. In order to provide patients and their relatives with better opportunities to express their EOL wishes, there is a need for clearer roles and guidelines in an interdisciplinary approach to EOL conversations, alongside improved staff competencies and changes to the organizational and physical environment.
背景
在医院进行临终（EOL）谈话的目的是让患者有机会考虑未来的治疗方案，并帮助他们在需要做出治疗决策之前澄清自己的价值观和意愿。然而，众所周知，医院并没有系统地进行 EOL 谈话。这可能意味着患者及其家属没有讨论 EOL 问题。对于谁负责进行这些谈话，以及何时以及在什么情况下进行这些谈话，人们知之甚少。本研究旨在探讨在急性护理医院环境中进行 EOL 谈话的现有实践。
方法
设计为解释性描述，数据收集方法包括：1. 在肺内科和外科病房进行参与式观察研究（共计 66 小时）；2. 对病房的医护人员（n=14）进行了 4 次焦点小组访谈。分析遵循斯普拉德利的民族语义分析。
结果
结果揭示了三个与以下内容相关的文化类别：1. 物理和组织环境；2. 进行 EOL 谈话的时间以及处理 EOL 问题的能力和角色；3. EOL 谈话中涉及的主题。EOL 谈话是日常临床实践的一部分，但缺乏能力，角色不明确，物理和组织环境不利于谈话。EOL 谈话的主题围绕着患者疾病进展的“此时此地”状态以及治疗水平的决策展开。在较小程度上，谈话还包括患者及其亲属对 EOL 的想法和愿望，这有助于进行长期护理规划。
结论
本研究表明，在急性护理医院环境中进行 EOL 谈话存在多种障碍，未来的策略必须采取整体方法。为了为患者及其家属提供更好的机会表达他们的 EOL 意愿，需要在跨学科方法中明确角色和准则，同时提高员工能力，并对组织和物理环境进行改进。
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