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“并肩而立,告诉家属真实情况”:一项定性研究探索姑息治疗临床医生对“以患者为中心的家庭会议”的看法。

"Standing Shoulder to Shoulder to Tell the Family What Was Really Going On": A Qualitative Study Exploring Palliative Care Clinicians' Perceptions of "Patient-Centered Family Meetings".

机构信息

School of Medicine, University of Notre Dame Australia, Darlinghurst, New South Wales, Australia.

Calvary Palliative and End of Life Care Research Institute, Calvary Health Care Kogarah, Kogarah, New South Wales, Australia.

出版信息

J Palliat Med. 2020 Oct;23(10):1307-1313. doi: 10.1089/jpm.2019.0380. Epub 2020 Apr 7.

DOI:10.1089/jpm.2019.0380
PMID:32267776
Abstract

Family meetings are often conducted in palliative care, but there is no universal agreed or accepted model. A new model of Patient-Centered Family Meetings is proposed whereby the patient sets the agenda. To seek palliative care clinicians' perceptions and experiences of Patient-Centered Family Meetings ("Meetings") and their acceptability and feasibility in the inpatient specialist palliative care setting. A qualitative study used semistructured interviews. Theoretical and procedural direction was taken from grounded theory with thematic content analysis using the constant comparative method. Interviews were conducted with clinicians ( = 10) at the intervention site who had participated in a Meeting. Four themes were identified: (1) a patient-set agenda gives patients a "voice"; (2) a patient-set agenda and the Meeting model enhances clinicians' understanding of patients and families; (3) the Meeting model was perceived to be acceptable; and (4) the Meeting model was perceived to be only feasible for selected patients. Clinicians perceived that a patient-set meeting agenda with defined questions enhanced their knowledge of the patient's issues and their understanding of the patient and their family's needs. The patients' most important issues often differed from the clinicians' expectations of what might be important to individual patients. There were contrasting views about the acceptability and feasibility of these Meetings as standard practice due to clinician time constraints and the Meeting not being required or relevant to all patients. Given the perceived benefits, the identification of patients and families who would most benefit is an important research priority.

摘要

家庭会议通常在姑息治疗中进行,但没有普遍同意或接受的模式。提出了一种新的以患者为中心的家庭会议模式,即由患者设定议程。旨在探讨姑息治疗临床医生对以患者为中心的家庭会议(“会议”)的看法和经验,以及其在住院专科姑息治疗环境中的可接受性和可行性。本研究采用定性研究方法,使用半结构式访谈。理论和程序方向来自扎根理论,使用恒定比较法进行主题内容分析。在干预现场,对参与会议的临床医生( = 10)进行了访谈。确定了四个主题:(1)患者设定的议程赋予患者“发言权”;(2)患者设定的议程和会议模式增强了临床医生对患者和家庭的理解;(3)会议模式被认为是可以接受的;(4)会议模式仅被认为对选定的患者可行。临床医生认为,带有明确问题的患者设定的会议议程增强了他们对患者问题的了解,以及对患者及其家庭需求的理解。患者最重要的问题往往与临床医生对个别患者可能重要的问题的期望不同。由于临床医生时间限制以及会议并非所有患者都需要或相关,对这些会议作为标准实践的可接受性和可行性存在不同看法。鉴于所感知的益处,确定最受益的患者和家庭是一个重要的研究优先事项。

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