Zigdon Avi, Nissanholtz-Gannot Rachel
Department of Health Systems Management, School of Health Sciences, Ariel University, Science Park, P.O.B. 3, 4070000, Ariel, Israel.
Smokler Center of Health Policy Research, Myers-JDC-Brookdale Institute, P.O.B. 3886, 91037, Jerusalem, Israel.
BMC Med Ethics. 2020 Dec 11;21(1):126. doi: 10.1186/s12910-020-00564-5.
Coping with end-of-life issues is a major challenge for governments and health systems. Despite progress in legislation, many barriers exist to its full implementation. This study is aimed at identifying these end-of-life barriers in relation to Israel.
Qualitative in-depth interviews using professionals and decision makers in the health-care and related systems (n = 37) were carried out, along with two focus groups based on brainstorming techniques consisting of nurses (n = 10) and social workers (n = 10). Data was managed and analyzed using Naralyzer software.
Qualitative analysis showed identification of six primary barriers: 1) law, procedures, and forms; 2) clinical aspects; 3) human aspects; 4) knowledge and skills of medical teams; 5) communication; and 6) resource allocation. These were further divided into 44 sub area barriers.
This study highlights the role of the family doctor in end-of-life by training physicians in decision-making workshops and increasing their knowledge in the field of palliative medicine. Effectively channeling resources, knowledge, and support for medical teams, by accounting for the structure and response of the units for home treatment will improve patient's access to information on and support for end-of-life laws, as well as reduce legislative barriers in other countries that face the same issues.
应对临终问题是政府和卫生系统面临的一项重大挑战。尽管在立法方面取得了进展，但在全面实施过程中仍存在许多障碍。本研究旨在确定以色列在临终方面的这些障碍。
对医疗保健及相关系统中的专业人员和决策者进行了定性深入访谈（n = 37），并基于头脑风暴技术开展了两个焦点小组讨论，一组由护士（n = 10）组成，另一组由社会工作者（n = 10）组成。使用Naralyzer软件对数据进行管理和分析。
定性分析显示确定了六个主要障碍：1）法律、程序和表格；2）临床方面；3）人文方面；4）医疗团队的知识和技能；5）沟通；6）资源分配。这些障碍进一步细分为44个次领域障碍。
本研究强调了家庭医生在临终关怀中的作用，通过在决策研讨会上培训医生并增加他们在姑息医学领域的知识。通过考虑家庭治疗单位的结构和反应，有效地为医疗团队提供资源、知识和支持，将改善患者获取临终法律信息和支持的机会，并减少其他面临相同问题国家的立法障碍。
