寻找自己的位置 - 全科医生在姑息治疗方面的经验-挪威的一项定性研究。
Finding their place - general practitioners' experiences with palliative care-a Norwegian qualitative study.
机构信息
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, Kristiansund, Norway.
出版信息
BMC Palliat Care. 2022 Jul 12;21(1):126. doi: 10.1186/s12904-022-01015-1.
BACKGROUND
Modern palliative care focuses on enabling patients to spend their remaining time at home, and dying comfortably at home, for those patients who want it. Compared to many European countries, few die at home in Norway. General practitioners' (GPs') involvement in palliative care may increase patients' time at home and achievements of home death. Norwegian GPs are perceived as missing in this work. The aim of this study is to explore GPs' experiences in palliative care regarding their involvement in this work, how they define their role, and what they think they realistically can contribute towards palliative patients.
METHODS
We performed focus group interviews with GPs, following a semi-structured interview guide. We included four focus groups with a total of 25 GPs. Interviews were recorded and transcribed verbatim. We performed qualitative analysis on these interviews, inspired by interpretative phenomenological analysis.
RESULTS
Strengths of the GP in the provision of palliative care consisted of characteristics of general practice and skills they relied on, such as general medical knowledge, being coordinator of care, and having a personal and longitudinal knowledge of the patient and a family perspective. They generally had positive attitudes but differing views about their formal role, which was described along three positions towards palliative care: the highly involved, the weakly involved, and the uninvolved GP.
CONCLUSION
GPs have evident strengths that could be important in the provision of palliative care. They rely on general medical knowledge and need specialist support. They had no consensus about their role in palliative care. Multiple factors interact in complex ways to determine how the GPs perceive their role and how involved they are in palliative care. GPs may possess skills and knowledge complementary to the specialized skills of palliative care team physicians. Specialized teams with extensive outreach activities should be aware of the potential they have for both enabling and deskilling GPs.
背景
现代姑息治疗注重使患者能够在家中度过剩余时间，并使希望在家中去世的患者舒适地在家中去世。与许多欧洲国家相比，挪威在家中去世的人数很少。全科医生（GP）参与姑息治疗可以增加患者在家中的时间，并实现在家中死亡的目标。挪威的全科医生在这项工作中被认为是缺失的。本研究旨在探讨全科医生在姑息治疗方面的经验，包括他们对这项工作的参与程度、如何定义自己的角色以及他们认为自己在姑息治疗患者方面能做出什么实际贡献。
方法
我们对全科医生进行了焦点小组访谈，采用半结构化访谈指南。我们共进行了 4 组焦点小组访谈，共有 25 名全科医生参加。访谈进行了录音，并逐字记录。我们对这些访谈进行了定性分析，灵感来自解释性现象学分析。
结果
全科医生在姑息治疗中的优势包括一般实践的特点和他们依赖的技能，如一般医学知识、作为护理协调者、对患者及其家庭有个人和纵向的了解。他们普遍持积极态度，但对自己的正式角色存在不同看法，这种看法可以分为三种：高度参与的、低度参与的和不参与的全科医生。
结论
全科医生具有在姑息治疗中非常重要的优势。他们依赖一般医学知识，需要专家支持。他们对自己在姑息治疗中的角色没有共识。多种因素以复杂的方式相互作用，决定了全科医生如何看待自己的角色以及他们在姑息治疗中的参与程度。全科医生可能拥有与姑息治疗团队医生的专业技能互补的技能和知识。具有广泛外展活动的专业团队应该意识到他们在使全科医生能够发挥作用和使他们失去技能方面的潜力。
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