Melbourne Medical School, 2281The University of Melbourne, Parkville, Victoria, Australia.
School of Allied Health, Human Services and Sport, 2080La Trobe University, Melbourne, Victoria, Australia.
Am J Hosp Palliat Care. 2022 Feb;39(2):211-219. doi: 10.1177/10499091211018664. Epub 2021 May 31.
Interstitial lung disease (ILD) is a debilitating and life-limiting condition, requiring multi-disciplinary care. While guidelines recommend early specialist palliative care referral to improve symptoms and quality of life, few patients access such care towards the end-of-life. This study aimed to explore clinicians' perspectives regarding specialist palliative care and opioids to understand barriers to optimal care and guide clinical practice improvement initiatives.
A cross-sectional, exploratory, qualitative study was undertaken with Australian respiratory clinicians caring for people with ILD (n = 17). In-depth, semi-structured interviews were audio-recorded, transcribed verbatim and coded. Thematic analysis was undertaken to extrapolate recurring ideas from the data.
Four themes were identified: 1) understanding how to improve patient care and support, 2) the need to dispel stigmatized beliefs and misconceptions, 3) the importance of trusted relationships and good communication and 4) the challenges of navigating the health-care system. Participants discussed the need to implement early specialist palliative care and symptom palliation to alleviate symptoms, provide emotional support and augment quality of life. Participants described challenges accessing palliative care and opioids due to stigmatized beliefs amongst patients and clinicians and difficulties navigating the health-care system. Trusted therapeutic relationships with patients and strong inter-disciplinary partnerships with collaborative education and communication were perceived to improve patients' access to symptom palliation.
Specialist palliative care and opioids were believed to improve patients' quality of life, however, many barriers can make accessing such care challenging. To address these issues, multi-disciplinary collaboration, high-quality communication and trusted therapeutic relationships are crucial throughout the ILD illness journey.
间质性肺病（ILD）是一种使人虚弱和危及生命的疾病，需要多学科的护理。尽管指南建议早期转介专业姑息治疗以改善症状和生活质量，但在生命末期，很少有患者能够获得此类护理。本研究旨在探讨临床医生对专业姑息治疗和阿片类药物的看法，以了解优化护理的障碍，并指导临床实践改进举措。
采用澳大利亚呼吸科临床医生照顾ILD 患者（n=17）的横断面、探索性、定性研究。对深入的半结构化访谈进行录音、逐字转录并进行编码。采用主题分析从数据中推断出反复出现的想法。
确定了四个主题：1）了解如何改善患者护理和支持，2）需要消除污名化的信念和误解，3）建立信任关系和良好沟通的重要性，4）应对医疗保健系统的挑战。参与者讨论了实施早期专业姑息治疗和症状缓解的必要性，以减轻症状、提供情感支持并提高生活质量。参与者描述了由于患者和临床医生的污名化信念以及在医疗保健系统中导航的困难而导致获得姑息治疗和阿片类药物的挑战。与患者建立信任的治疗关系以及与协作教育和沟通相结合的跨学科合作，被认为可以改善患者获得症状缓解的机会。
专业姑息治疗和阿片类药物被认为可以提高患者的生活质量，但许多障碍可能使获得此类护理具有挑战性。为了解决这些问题，在ILD 疾病全程中，多学科合作、高质量的沟通和信任的治疗关系至关重要。
