Research Department of Primary Care and Population Health, University College London, London, UK.
Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK.
Health Soc Care Community. 2022 Jan;30(1):e126-e137. doi: 10.1111/hsc.13419. Epub 2021 May 10.
Many patients with terminal cancer wish to die at home and general practitioners in the United Kingdom have a critical role in providing this care. However, it has been suggested general practitioners lack confidence in end-of-life care. It is important to explore with general practitioners their experience and perspectives including feelings of confidence delivering end-of-life care to people with cancer. The aim of this study was to explore general practitioners experiences of providing end-of-life care for people with cancer in the home setting and their perceptions of confidence in this role as well as understanding implications this has on policy design. A qualitative study design was employed using semi-structured interviews and analysed using thematic analysis. Nineteen general practitioners from London were purposively sampled from eight general practices and a primary care university department in 2018-2019, supplemented with snowballing methods. Five main themes were constructed: (a) the subjective nature of defining palliative and end-of-life care; (b) importance of communication and managing expectations; (c) complexity in prescribing; (d) challenging nature of delivering end-of-life care; (e) the unclear role of primary care in palliative care. General practitioners viewed end-of-life care as challenging; specific difficulties surrounded communication and prescribing. These challenges coupled with a poorly defined role created a spread in perceived confidence. Experience and exposure were seen as enabling confidence. Specialist palliative care service expansion had important implications on deskilling of essential competencies and reducing confidence levels in general practitioners. This feeds into a complex cycle of causation, leading to further delegation of care.
许多晚期癌症患者希望在家中离世，英国的全科医生在提供这种护理方面起着至关重要的作用。然而，有人认为全科医生对临终关怀缺乏信心。了解全科医生在临终关怀方面的经验和观点，包括他们对为癌症患者提供临终关怀的信心，是很重要的。本研究旨在探讨全科医生在家庭环境中为癌症患者提供临终关怀的经验，以及他们对这一角色的信心程度，并了解这对政策设计的影响。本研究采用定性研究设计，使用半结构式访谈，并采用主题分析进行分析。2018-2019 年，从伦敦的八家全科医生诊所和一家初级保健大学系中，有针对性地选择了 19 名全科医生作为研究对象，并采用滚雪球的方法进行补充。构建了五个主要主题：(a) 姑息治疗和临终关怀定义的主观性；(b) 沟通和管理期望的重要性；(c) 处方的复杂性；(d) 临终关怀的挑战性；(e) 初级保健在姑息治疗中的角色不明确。全科医生认为临终关怀具有挑战性；沟通和开处方具体困难。这些挑战加上角色定义不清，导致信心水平存在差异。经验和接触被认为是增强信心的因素。姑息治疗专科服务的扩展对基本能力的去技能化和降低全科医生的信心水平产生了重要影响。这导致了一个复杂的因果循环，进一步导致了护理的进一步委托。
