Section of Medical Ethics, Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands; Section of Geriatric Medicine, Department of Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
Section of Geriatric Medicine, Department of Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
J Pain Symptom Manage. 2020 Aug;60(2):372-380.e1. doi: 10.1016/j.jpainsymman.2020.02.018. Epub 2020 Mar 2.
Inadequate handovers between hospital and home can lead to adverse health outcomes. A group particularly at risk is patients at the end of life because of complex health problems, frequent care transitions, and involvement of many professionals.
To investigate health care providers' views and experiences with regard to the transition from hospital to primary care in palliative care.
This was a descriptive qualitative study. Three focus group discussions were held with 28 nurses and two focus groups with nine physicians. Participants were recruited from primary and hospital care. The focus groups were audiorecorded, transcribed verbatim, and analyzed thematically.
The following themes emerged from the data: lack of identification of and communication about the last phase of life; incomplete and insufficient handover; and uncertainty about responsibilities. Professionals emphasize the importance of proper handovers and transitional processes in these vulnerable patients. The transition between hospital to primary care is hindered by a lack of identification of the palliative phase and uncertainties about patient awareness. Direct communication between professionals is needed but lacking. The handover itself is currently primarily focused on physical aspects where psychosocial aspects were also found necessary. Furthermore, uncertainties with regard to physicians' responsibility for the patient seem to further hinder professionals in the transitional process.
Efforts should be made to enhance knowledge and skills around identification of palliative needs and communication with patients about the end of life, especially in the hospital setting.
医院与家庭之间交接不充分可能导致不良健康后果。特别是生命末期的患者面临较高风险，他们通常存在复杂的健康问题、频繁的护理交接以及涉及众多专业人员。
调查医护人员对临终关怀中从医院到初级保健过渡的看法和经验。
这是一项描述性定性研究。对 28 名护士和 2 名医生进行了 3 次焦点小组讨论。参与者来自初级保健和医院护理。对焦点小组进行了录音、逐字转录，并进行了主题分析。
数据中出现了以下主题：缺乏对生命末期的识别和沟通；交接不完整和不足；以及对责任的不确定性。专业人员强调在这些脆弱患者中适当交接和过渡过程的重要性。从医院到初级保健的过渡受到对姑息阶段缺乏识别和对患者意识不确定性的阻碍。专业人员之间需要直接沟通，但目前缺乏这种沟通。交接本身主要集中在身体方面，但也发现心理社会方面是必要的。此外，对医生对患者责任的不确定性似乎进一步阻碍了专业人员在过渡过程中的工作。
应努力提高对识别姑息需求和与患者就生命末期进行沟通的知识和技能，特别是在医院环境中。
