McCallan Tara, Daudt Helena
Moss Rock Medical, Island Health Palliative and End of Life Program and Victoria Hospice, Victoria, British Columbia, Canada.
UBC Faculty of Medicine, Vancouver, British Columbia, Canada.
Palliat Med Rep. 2021 Jul 16;2(1):207-211. doi: 10.1089/pmr.2021.0021. eCollection 2021.
Evidence shows the benefits of having a family physician (FP) at the heart of a care team that delivers palliative and end-of-life care (PEoLC). However, FPs have limitations on their ability to provide PEoLC. We conducted a quality improvement study to (1) explore the barriers FPs encounter in providing PEoLC in our metropolitan context and (2) identify potential strategies to overcome these challenges. We interviewed a cohort of FPs from 10 different clinical practices within a metropolitan area (British Columbia [BC], Canada); this cohort is not regularly engaged with our Specialist Palliative Care Team. Verbatim transcripts were examined using inductive thematic analysis. All FPs identified home visits as a critical aspect of being able to provide PEoLC. Despite this consensus, work-life balance, time, and compensation are major barriers to providing home visits and PEoLC. Local healthcare system awareness (available resources, why and how to access them) was identified as a barrier that can potentially be addressed through education sessions. Although 5 out of 10 FPs had not had formal palliative care education or training, clinical education was not considered a barrier to provide PEoLC. Providing FPs with tools and resources through education, including why and how to access them, and adjusting the BC compensation model to address home visit's travel time and time modifiers may better support FPs to provide PEoLC.
有证据表明，在提供姑息治疗和临终关怀（PEoLC）的护理团队中，配备一名家庭医生（FP）具有诸多益处。然而，家庭医生在提供PEoLC方面存在能力限制。我们开展了一项质量改进研究，以（1）探索在我们的大都市环境中，家庭医生在提供PEoLC时遇到的障碍，以及（2）确定克服这些挑战的潜在策略。我们采访了来自大都市地区（加拿大不列颠哥伦比亚省[BC]）10个不同临床实践机构的一组家庭医生；该组医生未与我们的专科姑息治疗团队定期合作。使用归纳主题分析法对逐字记录进行了检查。所有家庭医生都将家访视为能够提供PEoLC的关键因素。尽管达成了这一共识，但工作与生活的平衡、时间和薪酬是提供家访和PEoLC的主要障碍。当地医疗系统的认知（可用资源、获取资源的原因和方式）被确定为一个障碍，可通过教育课程来解决。虽然10名家庭医生中有5名没有接受过正式的姑息治疗教育或培训，但临床教育并未被视为提供PEoLC的障碍。通过教育为家庭医生提供工具和资源，包括获取资源的原因和方式，并调整BC薪酬模式以解决家访的出行时间和时间调整因素，可能会更好地支持家庭医生提供PEoLC。
