General Practice Research Unit, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, PO Box 8905 MTFS, N-7491, Trondheim, Norway.
Unit for Palliative Care and Chemotherapy Treatment, Cancer Department, More Og Romsdal Hospital Trust, Kristiansund Hospital, N-6508 Kristiansund N, Norway.
BMC Fam Pract. 2021 Apr 7;22(1):64. doi: 10.1186/s12875-021-01426-8.
Patients in need of palliative care often want to reside at home. Providing palliative care requires resources and a high level of competence in primary care. The Norwegian guideline for palliative care points to the central role of the regular general practitioner (RGP), specifying a high expected level of competence. Guideline implementation is known to be challenging in primary care. This study investigates adherence to the guideline, the RGPs experience with, and view of their role in palliative care.
A questionnaire was distributed, by post, to all 246 RGPs in a Norwegian county. Themes of the questionnaire focused on experience with palliative and terminal care, the use of recommended work methods from the guideline, communication with partners, self-reported role in palliative care and confidence in providing palliative care. Data were analyzed descriptively, using SPSS.
Each RGP had few patients needing palliative care, and limited experience with terminal care at home. Limited experience challenged RGPs possibilities to maintain knowledge about palliative care. Their clinical approach was not in agreement with the guideline, but most of them saw themselves as central, and were confident in the provision of palliative care. Rural RGPs saw themselves as more central in this work than their urban colleagues.
This study demonstrated low adherence of the RGPs, to the Norwegian guideline for palliative care. Guideline requirements may not correspond with the methods of general practice, making them difficult to adopt. The RGPs seemed to have too few clinical cases over time to maintain skills at a complex and specialized level. Yet, there seems to be a great potential for the RGP, with the inherent specialist skills of the general practitioner, to be a key worker in the palliative care trajectory.
需要姑息治疗的患者通常希望在家中居住。提供姑息治疗需要资源和初级保健方面的高度能力。挪威姑息治疗指南指出，常规全科医生（RGP）起着核心作用，并规定了高度期望的能力水平。众所周知，在初级保健中实施该指南具有挑战性。本研究调查了对该指南的遵守情况，RGP 对姑息治疗的经验和看法。
通过邮寄向挪威一个县的所有 246 名 RGP 分发了问卷。问卷的主题集中在姑息治疗和临终关怀方面的经验，使用指南中推荐的工作方法，与合作伙伴的沟通，自我报告的姑息治疗角色以及提供姑息治疗的信心。使用 SPSS 进行描述性数据分析。
每位 RGP 都只有少数需要姑息治疗的患者，并且在家中进行临终关怀的经验有限。有限的经验限制了 RGP 维持姑息治疗知识的可能性。他们的临床方法与指南不符，但大多数人认为自己是核心人物，并对提供姑息治疗充满信心。农村 RGP 认为自己在这项工作中比城市同行更为核心。
本研究表明，RGP 对挪威姑息治疗指南的遵从度较低。指南要求可能与一般实践方法不符，因此难以采用。随着时间的推移，RGP 的临床病例似乎太少，无法保持复杂和专业水平的技能。然而，RGP 似乎具有很大的潜力，因为普通医生具有内在的专业技能，可以成为姑息治疗轨迹中的关键工作者。
