家庭实践中提供姑息治疗方法的频率：加拿大的图表回顾和医疗保健从业者的看法。
Frequency of providing a palliative approach to care in family practice: a chart review and perceptions of healthcare practitioners in Canada.
机构信息
Department of Family Medicine, McMaster University, David Braley Health Sciences Centre 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada.
Division of Palliative Care, McMaster University, David Braley Health Sciences Centre 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada.
出版信息
BMC Fam Pract. 2021 Mar 27;22(1):58. doi: 10.1186/s12875-021-01400-4.
BACKGROUND
Most patients nearing the end of life can benefit from a palliative approach in primary care. We currently do not know how to measure a palliative approach in family practice. The objective of this study was to describe the provision of a palliative approach and evaluate clinicians' perceptions of the results.
METHODS
We conducted a descriptive study of deceased patients in an interprofessional team family practice. We integrated conceptual models of a palliative approach to create a chart review tool to capture a palliative approach in the last year of life and assessed a global rating of whether a palliative approach was provided. Clinicians completed a questionnaire before learning the results and after, on perceptions of how often they believed a palliative approach was provided by the team.
RESULTS
Among 79 patients (mean age at death 73 years, 54% female) cancer and cardiac diseases were the top conditions responsible for death. One-quarter of patients were assessed as having received a palliative approach. 53% of decedents had a documented discussion about goals of care, 41% had nurse involvement, and 15.2% had a discussion about caregiver well-being. These indicators had the greatest discrimination between a palliative approach or not. Agreement that elements of a palliative approach were provided decreased significantly on the clinician questionnaire from before to after viewing the results.
CONCLUSIONS
This study identified measurable indicators of a palliative approach in family practice, that can be used as the basis for quality improvement.
背景
大多数生命末期的患者都可以从初级保健中的姑息治疗方法中受益。我们目前还不知道如何在家庭实践中衡量姑息治疗方法。本研究的目的是描述姑息治疗方法的实施情况，并评估临床医生对结果的看法。
方法
我们对一个跨专业团队家庭实践中的已故患者进行了描述性研究。我们整合了姑息治疗方法的概念模型，创建了一个图表审查工具，以捕捉生命最后一年的姑息治疗方法，并评估了提供姑息治疗方法的总体评分。临床医生在了解结果之前和之后完成了一份问卷，就他们认为团队提供姑息治疗方法的频率进行了评估。
结果
在 79 名患者中（死亡时的平均年龄为 73 岁，54%为女性），癌症和心脏病是导致死亡的主要疾病。四分之一的患者被评估为接受了姑息治疗方法。53%的死者有记录的关于护理目标的讨论，41%有护士参与，15.2%有关于照顾者福祉的讨论。这些指标在姑息治疗方法或不提供之间具有最大的区分度。在查看结果之前和之后，临床医生问卷中认为姑息治疗方法提供的要素的一致性显著下降。
结论
本研究确定了家庭实践中姑息治疗方法的可衡量指标，可以作为质量改进的基础。
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