Primary Care Unit, University of Cambridge, Cambridge, UK
Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
BMJ Support Palliat Care. 2022 Dec;12(e6):e862-e868. doi: 10.1136/bmjspcare-2019-001954. Epub 2019 Nov 13.
Palliative and end-of-life care is a core competency for doctors and is increasingly recognised as a key clinical skill for junior doctors. There is a growing international movement to embed palliative care education in medical student and junior doctor education. To date there has been no review of the literature concerning the views and experiences of junior doctors delivering this care.
To review the published literature between 2000 and 2019 concerning junior doctors' experience of palliative and end-of-life care.
Systematic literature review and narrative synthesis.
A search of six databases identified 7191 titles; 34 papers met the inclusion criteria, with a further 5 identified from reference searching. Data were extracted into a review-specific extraction sheet and a narrative synthesis undertaken. Three key themes were identified: (1) 'Significance of death and dying': all papers found that junior doctors care for many patients approaching the end of life, and this often causes emotional distress and can leave persisting memories for many years afterwards; (2) 'Thrown in at the deep end': junior doctors feel unprepared and unsupported in providing palliative and end-of-life care; and (3) 'Addressing the gaps': junior doctors often experience a medical culture of disengagement towards dying patients and varying attitudes of senior doctors. Subsequently they have to learn the skills needed through seeking their own opportunities.
Medical education needs to change in order to better prepare and support junior doctors for their role in caring for dying patients. This education needs to focus on their knowledge, skills and attitudes.
姑息治疗和临终关怀是医生的核心能力，越来越多的人认识到姑息治疗是初级医生的一项关键临床技能。国际上越来越重视将姑息治疗教育纳入医学生和初级医生的教育中。迄今为止，尚未对初级医生提供此类护理的观点和经验进行文献综述。
回顾 2000 年至 2019 年期间有关初级医生姑息治疗和临终关怀经验的文献。
系统文献综述和叙述性综合。
对六个数据库进行搜索，共确定了 7191 个标题；34 篇论文符合纳入标准，另有 5 篇是从参考文献中找到的。将数据提取到专门的综述提取表中，并进行叙述性综合。确定了三个关键主题：（1）“死亡和临终的意义”：所有论文都发现，初级医生照顾了许多接近生命终点的患者，这常常导致情绪困扰，并在多年后留下持久的记忆；（2）“仓促上阵”：初级医生在提供姑息治疗和临终关怀方面感到准备不足且缺乏支持；（3）“解决差距”：初级医生经常体验到一种对临终患者不参与的医疗文化，以及资深医生的不同态度。随后，他们必须通过寻找自己的机会来学习所需的技能。
医学教育需要改变，以更好地为初级医生在照顾临终患者方面的角色做好准备和支持。这种教育需要侧重于他们的知识、技能和态度。
