维持性血液透析患者的终末期和姑息治疗：一项焦点小组研究。
End-of-life and palliative care of patients on maintenance hemodialysis treatment: a focus group study.
机构信息
Department of Nursing Science, Sophiahemmet University, Box 5605, 114 86, Stockholm, Sweden.
Centre for Collaborative Palliative Care, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.
出版信息
BMC Palliat Care. 2019 Oct 30;18(1):89. doi: 10.1186/s12904-019-0481-y.
BACKGROUND
Despite complex illness trajectories and a high symptom burden, palliative care has been sub-optimal for patients with end-stage kidney disease and hemodialysis treatment who have a high rate of hospitalization and intensive care towards end of life. There is a growing awareness that further development of palliative care is required to meet the needs of these patients and their family members. In this process, it is important to explore healthcare professionals' views on provision of care. The aim of this study was therefore to describe nurses' and physicians' perspectives on end-of-life and palliative care of patients treated with maintenance hemodialysis.
METHODS
Four focus group interviews were conducted with renal nurses (17) and physicians (5) in Sweden. Qualitative content analysis was used to analyze data.
RESULTS
Participants were committed to giving the best possible care to their patients, but there were challenges and barriers to providing quality palliative care in nephrology settings. Professionals described palliative care as end-of-life care associated with hemodialysis withdrawal or palliative dialysis, but also identified care needs and possibilities that are in line with an earlier integrated palliative approach. This was perceived as complex from an organizational point of view. Participants identified challenges related to coordination of care and different perspectives on care responsibilities that impacted symptom management and patients' quality of life. Communication issues relating to the provision of palliative care were revealed where the hemodialysis setting was regarded as an impediment, and personal and professional experiences, beliefs and knowledge were considered of major importance.
CONCLUSIONS
Nurses and physicians identified a need for the improvement of both late and earlier palliative care approaches. The results highlighted a requirement for and possibilities of training, counselling and support of health care professionals in the dialysis context. Further, multi-professional palliative care collaborations should be developed to improve the coordination and organization of end-of-life and palliative care of patients and their family members. A climate allowing conversations about advance care planning throughout the illness trajectory may facilitate the gradual integration of palliative care alongside life-prolonging treatment for improved support of patients and families.
背景
尽管患有终末期肾病并接受血液透析治疗的患者病情复杂，且症状负担沉重，但他们的临终关怀仍不理想，这些患者的住院率和生命末期的重症监护率都很高。人们越来越意识到，需要进一步发展姑息治疗，以满足这些患者及其家属的需求。在这个过程中，探索医疗保健专业人员对护理服务的看法很重要。因此，本研究的目的是描述接受维持性血液透析治疗的患者的临终关怀和姑息治疗方面，护士和医生的观点。
方法
在瑞典，对 17 名肾脏护士和 5 名医生进行了 4 次焦点小组访谈。采用定性内容分析法对数据进行分析。
结果
参与者致力于为患者提供尽可能好的护理，但在肾病学环境中提供高质量姑息治疗存在挑战和障碍。专业人员将姑息治疗描述为与血液透析撤去或姑息性透析相关的临终关怀，但也确定了符合早期综合姑息治疗方法的护理需求和可能性。从组织的角度来看，这被认为是复杂的。参与者发现与护理协调相关的挑战以及对护理责任的不同看法，这影响了症状管理和患者的生活质量。在提供姑息治疗方面的沟通问题也被揭示出来，血液透析环境被认为是一个障碍，个人和专业经验、信仰和知识被认为是非常重要的。
结论
护士和医生确定需要改进晚期和早期姑息治疗方法。结果强调了在透析环境中对卫生保健专业人员进行培训、咨询和支持的必要性和可能性。此外，应该发展多专业姑息治疗合作，以改善患者及其家属的临终关怀和姑息治疗的协调和组织。允许在整个疾病过程中就预先护理计划进行对话的氛围，可能有助于姑息治疗与延长生命的治疗逐渐融合，从而改善对患者和家庭的支持。
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