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探讨临终癌症患者的家庭姑息治疗中卫生保健提供者的认知。

Exploring health care providers' perceptions about home-based palliative care in terminally ill cancer patients.

机构信息

Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran.

Department of Community Health Nursing, School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran.

出版信息

BMC Palliat Care. 2019 Aug 6;18(1):66. doi: 10.1186/s12904-019-0452-3.

Abstract

BACKGROUND

According to the World Health Organization, palliative care is one of the main components of healthcare. As the incidence of cancer is increasing in the world, home-based palliative care can be beneficial for many patients. This study was designed to explore health care providers' perceptions about home-based palliative care in terminally ill cancer patients.

METHODS

This qualitative study was carried out using the conventional content analysis from October 2016 to September 2018 in Iran. Participants were home care providers who were selected using purposive sampling. The data were collected through 18 individual interviews, and a focus group meeting. Data were analyzed based on the method proposed by Lundman and Graneheim.

RESULTS

from the data analysis, 511 initial codes were extracted, which were categorized into the two main categories of challenges and opportunities for home-based palliative care and 10 subcategories. The subcategories of challenges included deficiencies in inter-sectoral and inter-professional cooperation, lack of infrastructures for end-of-life care, challenges related to the management of death, challenges of transferring patients to home, providing non-academic palliative care, lack of political commitment of the government and Spiritual vacuum. The category of opportunities included subcategories of cost-effectiveness, moving towards socializing health, and structure of the health system.

CONCLUSIONS

Home-based palliative care requires government and health system support. Structural and process modification in the healthcare can provide conditions in which terminally ill cancer patients receive appropriate care in home and experience death with dignity through support of family, friends and healthcare.

摘要

背景

世界卫生组织认为,姑息治疗是医疗保健的主要组成部分之一。随着全球癌症发病率的上升,基于家庭的姑息治疗可能对许多患者有益。本研究旨在探讨医疗保健提供者对终末期癌症患者家庭姑息治疗的看法。

方法

这是一项 2016 年 10 月至 2018 年 9 月在伊朗进行的定性研究,采用常规内容分析法。参与者是家庭护理提供者,他们是通过目的抽样选择的。通过 18 次个人访谈和一次焦点小组会议收集数据。根据 Lundman 和 Graneheim 提出的方法进行数据分析。

结果

从数据分析中提取了 511 个初始代码,将其分为家庭姑息治疗的挑战和机遇两个主要类别和 10 个子类别。挑战的子类别包括部门间和专业间合作不足、临终关怀基础设施缺乏、与死亡管理相关的挑战、将患者转移到家庭的挑战、提供非学术姑息治疗、缺乏政府的政治承诺和精神空虚。机遇的范畴包括具有成本效益、走向社会化健康和卫生系统结构的子范畴。

结论

家庭姑息治疗需要政府和卫生系统的支持。医疗保健的结构和流程的改变可以为终末期癌症患者在家庭中获得适当的护理提供条件,并通过家庭、朋友和医疗保健的支持,使他们有尊严地面对死亡。

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