Institute for General Practice, Hannover Medical School, Hannover, Germany.
Medical Sociology Unit, Hannover Medical School, Hannover, Germany.
Ger Med Sci. 2020 Nov 16;18:Doc10. doi: 10.3205/000286. eCollection 2020.
General practitioners (GPs) play a key role in the provision of general outpatient palliative care (AAPV) for the majority of patients at the end of life. The aim of this study was to evaluate the quality of End-of-Life Care (EoLC) from a GPs' perspective using the German version of the General Practice End of Life Care Index (GP-EoLC-I). Between autumn 2018 and spring 2019, all registered and eligible GPs in two counties in Lower Saxony (n=190) were asked to participate in a survey on EoLC using the German version of the self-assessment questionnaire GP-EoLC-I. The index comprises two subscales: (13 items) and (12 items). The summated index of both subscales measures the quality of EoLC by GPs (25 items; range 14-40). The questionnaire was supplemented by questions on sociodemographic data, indicators for good palliative care (PC) and requirements to improve PC. Quantitative data were analysed by descriptive statistics and free text answers by conventional content analysis according to Hsieh and Shannon. 52 GPs (females: n=16) of 34 practices (single practices: n=26) participated in the study. The mean GP-EoLC-I was 27.5 (SD 4.5). The items revealed potential for improvement: systematic identification of patients with potential PC needs, multidisciplinary case conferences to discuss PC patients, application of care protocols and symptom assessment tools, documentation of patients' wishes and beliefs as well as inclusion of family and carers. Regarding the indicators for good PC, the most relevant indicators from the GPs' perspective were collaboration and coordination, integration of relatives, advance care planning and documentation. As requirements to improve PC, GPs highlighted further training and the use of standardised tools such as instruments to support the systematic identification of PC patients. To our knowledge for the first time in Germany, an internationally tested self-assessment questionnaire measuring the quality of EoLC by GPs was applied. The GP-EoLC-I in this study was slightly lower than the index of GPs in the United Kingdom. Including relatives and family carers, implementing tools to support early identification of PC patients and strengthening cooperation between GPs and other stakeholders in PC may be promising approaches to improve general PC and EoLC in Germany.
全科医生（GP）在为大多数临终患者提供普通门诊姑息治疗（AAPV）方面发挥着关键作用。本研究的目的是使用德国版一般实践临终关怀指数（GP-EoLC-I）从 GP 的角度评估临终关怀质量（EoLC）。 2018 年秋季至 2019 年春季，下萨克森州两个县的所有注册和合格的全科医生（n=190）被要求使用自我评估问卷 GP-EoLC-I 的德国版参与临终关怀调查。该指数包括两个分量表：（13 项）和（12 项）。两个分量表的总和指数衡量 GP 的 EoLC 质量（25 项；范围 14-40）。问卷还补充了有关社会人口数据、良好姑息治疗（PC）指标和改善 PC 的要求的问题。定量数据通过描述性统计进行分析，自由文本答案通过 Hsieh 和 Shannon 的常规内容分析进行分析。 34 家实践（单一实践：n=26）中的 52 名 GP（女性：n=16）参加了这项研究。平均 GP-EoLC-I 为 27.5（SD 4.5）。这些项目显示出改进的潜力：系统地识别有潜在 PC 需要的患者、多学科病例会议讨论 PC 患者、应用护理方案和症状评估工具、记录患者的意愿和信念以及包括家属和照顾者。关于良好 PC 的指标，从 GP 的角度来看，最相关的指标是协作和协调、亲属的整合、预先护理计划和文档记录。作为改善 PC 的要求，GP 强调进一步培训和使用标准化工具，如支持系统识别 PC 患者的工具。 据我们所知，这是德国首次应用国际上经过测试的自我评估问卷来衡量 GP 的 EoLC 质量。本研究中的 GP-EoLC-I 略低于英国 GP 的指数。纳入亲属和家庭照顾者，实施支持早期识别 PC 患者的工具，并加强 GP 与其他 PC 利益相关者之间的合作，可能是改善德国普通 PC 和 EoLC 的有前途的方法。
