School of Nursing & Midwifery, Trinity College Dublin, The University of Dublin, Ireland.
Palliat Med. 2020 May;34(5):605-618. doi: 10.1177/0269216319899335. Epub 2020 Feb 5.
Healthcare providers working in hospitals are frequently exposed to patients with palliative care needs. For most patients, these reflect non-specialist rather than specialist palliative care needs. Embedding palliative care principles early in patients' disease trajectories within acute care delivery in hospitals, however, is a challenge. How to best understand the experiences of those providing non-specialist palliative care in hospitals has not been systematically assessed.
To synthesise the evidence on healthcare providers' views and experiences of non-specialist palliative care in hospitals.
A qualitative systematic review and thematic synthesis using Thomas and Harden's thematic synthesis framework.
Databases of MEDLINE, CINAHL, PsycINFO and EMBASE were searched from date of inception to March 2018. Studies were eligible for inclusion if they reported on healthcare providers' views and experiences of non-specialist palliative care in hospitals. Studies were appraised for quality but not excluded on that basis. The review was prospectively registered with the International Prospective Register of Systematic Reviews.
Thirty-nine papers of 37 studies were included, representing 985 hospital healthcare providers' views and experiences. Four major analytical themes emerged; 'Understanding of Palliative Care', 'Complexities of Communication', 'Hospital Ecosystem' and 'Doctors and Nurses - a Different Lens'.
Non-specialist palliative care in hospitals is operationalised as care in the last weeks and days of life. The organisation of acute care, inter-disciplinary working practices, clinician attitudes, poor communication structures and lack of education and training in palliative care principles exacerbates poor implementation of this care earlier for patients in hospitals.
在医院工作的医疗保健提供者经常接触到需要姑息治疗的患者。对于大多数患者来说，这些反映的是非专业姑息治疗需求，而不是专业姑息治疗需求。然而，在医院的急性护理服务中尽早将姑息治疗原则嵌入到患者的疾病轨迹中是一项挑战。如何最好地理解在医院提供非专业姑息治疗的人员的经验尚未得到系统评估。
综合有关医疗保健提供者对医院中非专业姑息治疗的看法和经验的证据。
采用托马斯和哈登的主题综合框架进行定性系统评价和主题综合。
从建库日期到 2018 年 3 月，对 MEDLINE、CINAHL、PsycINFO 和 EMBASE 数据库进行了检索。如果研究报告了医疗保健提供者对医院中非专业姑息治疗的看法和经验，则符合纳入标准。对研究进行了质量评估，但没有基于该标准进行排除。该综述已在国际前瞻性系统评价注册库中进行了前瞻性注册。
纳入了 37 项研究的 39 篇论文，代表了 985 名医院医疗保健提供者的观点和经验。出现了四个主要的分析主题：“姑息治疗的理解”、“沟通的复杂性”、“医院生态系统”和“医生和护士-不同视角”。
医院中的非专业姑息治疗被视为生命最后几周和几天的治疗。急性护理的组织、跨学科工作实践、临床医生的态度、沟通结构不佳以及缺乏姑息治疗原则的教育和培训，使这种护理在医院中的早期实施更加困难。
