McCormack Fiona, Hopley Rachel, Kurth Judith, Iqbal Zafar
Centre for Health and Development (CHAD), School of Health, Science and Wellbeing, Staffordshire University, Stoke-on-Trent ST4 2DF, UK.
Institute for Community Research and Development (ICRD), Faculty of Arts, Business and Social Sciences, University of Wolverhampton, Wolverhampton WV1 1AD, UK.
Healthcare (Basel). 2021 Sep 29;9(10):1294. doi: 10.3390/healthcare9101294.
(1) Background: There remains a lack of sufficient progress in enhancing quality of care for patients experiencing end-of-life. This study aimed to better understand the views of doctors on how to improve end-of-life healthcare, in light of existing challenges and processes. (2) Methods: This qualitative descriptive study used semi-structured individual interviews. Through purposive sampling, sixteen doctors from primary care (three general practices) or acute care (one National Health Service hospital trust) participated. Interviews were audio-recorded, transcribed and thematic analysis conducted. (3) Results: Two main themes were identified: First, planning for patient-centred care-conversations about end-of-life care should take place earlier to allow for care that is planned and personalised. The need for more training and improvements to documenting patient wishes were highlighted. Second, delivering on patients' wishes: improvements to the healthcare system-the importance of a record of patient wishes that can be shared across the system was identified. Improved utilisation of available resources is also needed to better deliver quality patient-centred care. (4) Conclusion: More effective communication and coordination across acute and primary care settings is needed. The importance of patient wishes and advance care planning was emphasised. More guidance at a strategic level may help provide clarity about expectations, roles and responsibilities.
(1)背景:在提高临终患者护理质量方面仍缺乏足够进展。本研究旨在根据现有挑战和流程,更好地了解医生对于如何改善临终医疗保健的看法。(2)方法:本定性描述性研究采用半结构化个人访谈。通过目的抽样,来自初级保健(三个全科诊所)或急性护理(一个国民健康服务医院信托机构)的16名医生参与其中。访谈进行了录音、转录并开展了主题分析。(3)结果:确定了两个主要主题:第一,以患者为中心的护理规划——关于临终护理的对话应更早进行,以便提供有计划的个性化护理。强调了对更多培训的需求以及对记录患者意愿的改进。第二,实现患者意愿:改善医疗保健系统——确定了患者意愿记录在整个系统中共享的重要性。还需要更好地利用现有资源,以提供更高质量的以患者为中心的护理。(4)结论:急性护理和初级保健环境之间需要更有效的沟通与协调。强调了患者意愿和预先护理规划的重要性。战略层面上更多的指导可能有助于明确期望、角色和责任。