Xiangya School of Nursing, Central South University, Changsha, People's Republic of China.
School of Population and Global Health, The University of Western Australia, Perth, Australia.
Health Soc Care Community. 2022 Nov;30(6):e5145-e5155. doi: 10.1111/hsc.13931. Epub 2022 Aug 2.
Previous research on general practitioners' (GPs') involvement in end-of-life care has largely focused on a specific aspect of care or has provided broad overviews that failed to capture individual variations in patient management. This qualitative study aimed to explore Australian GPs' feedback and reflections on the individual-level care provided for patients in their last year of life. The findings of the study were drawn from a nation-wide survey of GPs' experiences in end-of-life care. We analysed responses from 63 GPs for 267 of the 272 reported deaths. Factors influencing delivery of optimal end-of-life care reported by GPs were categorised into four groups: patient-related factors, carer-related factors, interactions between GPs and patients/carer-related factors and broader health system issues. Each group included both barriers and facilitators. Our study highlighted importance of the emotional dimensions of therapeutic relationships with patients and their family, availability and capacity of family support and smooth communication and continuity of care between GPs and hospitals in delivery of optimal end-of-life care. Lack of these facilitators, misconceptions of palliative care and conflicts on implementing care plans among patients and their family tended to impede delivery of such care. On the basis of our findings in the present study and previous literature, we conclude that improved end-of-life care in general practice requires comprehensive approaches to supporting both the GP and family to provide care in patients' preferred place, such as enhanced palliative care training and improved availability of external support for GPs, higher levels of hospital-based services reaching into community settings and broader community-based resources for families beyond simply the healthcare system.
先前有关全科医生（GP）参与临终关怀的研究主要集中在护理的特定方面，或者提供了广泛的概述，未能捕捉到患者管理中的个体差异。这项定性研究旨在探讨澳大利亚全科医生对患者生命最后一年提供的个体化护理的反馈和反思。该研究的结果来自对全科医生临终关怀经验的全国性调查。我们分析了 63 名全科医生对 272 例报告死亡病例中的 267 例的回应。全科医生报告的影响提供最佳临终关怀的因素分为四组：患者相关因素、照顾者相关因素、全科医生与患者/照顾者相关因素之间的相互作用以及更广泛的卫生系统问题。每个组都包括障碍和促进因素。我们的研究强调了与患者及其家属的治疗关系的情感维度、家庭支持的可用性和能力以及全科医生和医院之间沟通和护理连续性对提供最佳临终关怀的重要性。缺乏这些促进因素、对姑息治疗的误解以及患者及其家属在实施护理计划方面的冲突，往往会阻碍这种护理的提供。根据我们在本研究和以前文献中的发现，我们得出结论，改善全科实践中的临终关怀需要采取综合方法来支持全科医生和家庭为患者提供他们所期望的地方的护理，例如加强姑息治疗培训和提高全科医生的外部支持可用性、提高医院为社区提供的服务水平，以及为家庭提供超越医疗保健系统的更广泛的社区资源。
