全科医生在启动临终谈话方面的实用方法：一项定性研究。
General practitioners' practical approach to initiating end-of-life conversations: a qualitative study.
机构信息
Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Herston, Australia.
The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Woolloongabba, Australia.
出版信息
Fam Pract. 2020 Jul 23;37(3):401-405. doi: 10.1093/fampra/cmz074.
BACKGROUND
As doctors who provide care across the life-course, general practitioners (GPs) play a key role in initiating timely end-of-life discussions. Nonetheless, these discussions are often not initiated until close to death. Given the ageing of the population, GPs will be confronted with end-of-life care more often, and this needs to become a core skill for all GPs.
OBJECTIVE
To describe GPs' approach to initiating end-of-life discussions.
METHODS
Fifteen GPs or GP trainees from South-East Queensland, Australia, were purposively recruited to participate in a semi-structured interview. We analysed transcripts using a thematic analysis.
RESULTS
GPs' approach to initiating end-of-life discussions was summarized by four themes: (1) Preparing the ground; (2) finding an entry point; (3) tailoring communication and (4) involving the family.
CONCLUSIONS
Emphasis on the doctor-patient relationship; assessing patient readiness for end-of-life discussions; and sensitive information delivery is consistent with factors previously reported to be important to both GPs and patients in this context. Our findings provide a framework for GPs initiating end-of-life discussions, which must be tailored to patient and GP personality factors. Further research is required to evaluate its outcomes.
背景
作为提供全生命周期医疗服务的医生，全科医生在及时启动临终讨论方面发挥着关键作用。然而，这些讨论往往直到接近死亡时才开始。鉴于人口老龄化，全科医生将更频繁地面临临终关怀，这需要成为所有全科医生的核心技能。
目的
描述全科医生启动临终讨论的方法。
方法
从澳大利亚昆士兰州东南部挑选了 15 名全科医生或全科医生培训生，有目的地邀请他们参加半结构化访谈。我们使用主题分析方法对转录本进行了分析。
结果
全科医生启动临终讨论的方法可以概括为四个主题：（1）准备基础；（2）寻找切入点；（3）调整沟通方式；（4）涉及家庭。
结论
重视医患关系；评估患者对临终讨论的准备情况；以及敏感信息的传递，这与之前在这种情况下对全科医生和患者都很重要的因素一致。我们的研究结果为全科医生启动临终讨论提供了一个框架，必须根据患者和全科医生的个性因素进行调整。需要进一步研究来评估其结果。
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