School of Nursing, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand; and Corresponding author. Email:
School of Nursing, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
Aust J Prim Health. 2020 Apr;26(2):124-131. doi: 10.1071/PY19081.
This exploratory study examined general practitioners' (GPs) perspectives on delivering end-of-life care in the New Zealand residential aged care context. A general inductive approach to the data collected from semi-structured interviews with 17 GPs from 15 different New Zealand general practices was taken. Findings examine: (1) GPs' life experience; (2) the GP relationship with the facilities and provision of end-of-life care; (3) the GP interaction with families of dying residents; and (4) GP relationship with hospice. The nature of the GP relationship with the facility influenced GP involvement in end-of-life care in aged care facilities, with GPs not always able to direct a facility's end-of-life care decisions for specific residents. GP participation in end-of-life care was constrained by GP time availability and the costs to the facilities for that time. GPs reported seldom using hospice services for residents, but did use the reputation (cachet) associated with hospice practices to provide an authoritative buffer for their end-of-life clinical decisions when talking with families and residents. GP training in end-of-life care, especially for those with dementia, was reported as ad hoc and done through informal mentoring between GPs.
本探索性研究考察了全科医生在新西兰养老院环境中提供临终关怀的观点。从 15 家不同的新西兰全科医生诊所的 17 名全科医生进行的半结构化访谈中收集的数据采用了一般归纳方法。研究结果探讨了：（1）全科医生的生活经历；（2）全科医生与设施的关系以及临终关怀的提供；（3）全科医生与临终居民家属的互动；（4）全科医生与临终关怀的关系。全科医生与医疗机构的关系性质影响全科医生在养老院临终关怀中的参与度，全科医生并不总是能够为特定居民指导医疗机构的临终关怀决策。全科医生参与临终关怀受到全科医生时间可用性和医疗机构为此时间付费的限制。全科医生报告很少为居民使用临终关怀服务，但确实利用临终关怀实践的声誉（威望）为他们与家属和居民交谈时的临终临床决策提供权威缓冲。临终关怀培训，特别是针对痴呆症患者的培训，被报告为临时的，并通过全科医生之间的非正式指导进行。
