全科医生参与临终关怀：一项半结构式访谈研究。

General practitioners' engagement in end-of-life care: a semi-structured interview study.

作者信息

Deckx Laura, Mitchell Geoffrey, Rosenberg John, Kelly Michaela, Carmont Sue-Ann, Yates Patsy

机构信息

Primary Care Clinical Unit, School of Clinical Medicine, University of Queensland, Brisbane, Queensland, Australia.

Primary Care Clinical Unit, School of Clinical Medicine, University of Queensland, Brisbane, Queensland, Australia

出版信息

BMJ Support Palliat Care. 2019 Sep 3. doi: 10.1136/bmjspcare-2019-001817.

DOI:10.1136/bmjspcare-2019-001817

PMID:31481475

Abstract

BACKGROUND

Early identification of approaching end-of-life and care planning improve outcomes at the end of life. Nevertheless, the majority of people who die are not identified in time to enable appropriate care planning. We aimed to describe the challenges general practitioners (GPs) found in providing end-of-life care; what prompted GPs to identify and discuss approaching end of life with their patient and how their practice changed.

METHODS

We conducted a qualitative study of 15 Australian GPs using semi-structured interviews, examining end-of-life care of one of their randomly selected, deceased patients. Interviews were analysed using a general inductive approach.

RESULTS

When a life-limiting prognosis was articulated, GPs integrated end-of-life care into their clinical care directly. Care often included a care plan developed in consultation with the patient. Even when death was not articulated, GPs were aware of approaching end of life and changed their focus to comfort of the patient. GPs generally had an informal care plan in mind, but this developed gradually and without discussing these plans with the patient. How GPs provided end-of-life care depended primarily on patient traits (eg, willingness to discuss physical decline) and the GP's characteristics (eg, experience, training and consulting style).

CONCLUSIONS

GPs were aware of their patients' approaching end of life and care was adjusted accordingly. However, under certain circumstances this was not explicitly articulated and discussed. It is not clear if implicit but unarticulated end-of-life care is sufficient to meet patients' needs. Future studies should investigate this.

摘要

背景

尽早识别临终状态并进行护理规划可改善临终结局。然而，大多数临终患者未能及时被识别，从而无法进行适当的护理规划。我们旨在描述全科医生（GP）在提供临终护理时所面临的挑战；促使全科医生识别并与患者讨论临终状态的因素，以及他们的做法有何改变。

方法

我们对15名澳大利亚全科医生进行了定性研究，采用半结构化访谈，考察他们随机选择的一名已故患者的临终护理情况。访谈采用一般归纳法进行分析。

结果

当明确了有限生命预后时，全科医生直接将临终护理纳入其临床护理中。护理通常包括与患者协商制定的护理计划。即使未明确提及死亡，全科医生也意识到患者临近生命终点，并将关注点转向患者的舒适度。全科医生通常心中有一个非正式的护理计划，但这个计划是逐渐形成的，且未与患者讨论这些计划。全科医生提供临终护理的方式主要取决于患者的特质（例如，是否愿意讨论身体机能衰退）和全科医生的特点（例如，经验、培训和咨询风格）。