Huperz Carolin, Sturm Noemi, Frick Eckhard, Mächler Ruth, Stolz Regina, Schalhorn Friederike, Valentini Jan, Joos Stefanie, Straßner Cornelia
Institute for General Practice and Palliative Care, Hannover Medical School, Hannover, Germany.
Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany.
Fam Pract. 2023 Mar 28;40(2):369-376. doi: 10.1093/fampra/cmac106.
Spiritual needs gain importance in old age but are often ignored in health care. Within the 'Holistic care program for elderly patients to integrate spiritual needs, social activity and self-care into disease management in primary care (HoPES3)' a complex intervention was evaluated in a cluster-randomized trial. The aim of this study was to explore the acceptability, feasibility, benefits, and harms of a spiritual history taken by general practitioners (GPs) as part of the complex intervention.
In this mixed-methods study telephone interviews with 11 German GPs and 12 medical assistants (MAs) of the HoPES3 intervention group were conducted and analysed using a content-analytical approach. Furthermore, GPs were asked to complete a questionnaire after each spiritual history. One hundred and forty-one questionnaires from 14 GPs were analysed descriptively.
GPs considered the spiritual history very/quite helpful for the patient in 27% (n= 38) and very/quite stressful in 2% (n = 3) of the cases. Interviews indicated that GPs found discussing spiritual history easier than anticipated. GPs and MAs saw a difficulty in that many patients associated spirituality with religion or church and reacted with surprise or rejection. Benefits for patients were seen in the opportunity to talk about non-medical topics, and increased awareness of their own resources. Benefits for GPs mainly related to information gain and an intensified patient-physician relationship.
A spiritual history in general practice has the potential to reveal important information about patients' lives and to improve the patient-physician relationship. Implementation barriers identified in this study have to be considered and addressed.
精神需求在老年阶段变得愈发重要，但在医疗保健中常常被忽视。在“老年患者整体护理计划：将精神需求、社交活动和自我护理纳入初级保健疾病管理（HoPES3）”中，一项复杂干预措施在一项整群随机试验中得到评估。本研究的目的是探讨全科医生（GP）进行精神病史询问作为复杂干预措施一部分的可接受性、可行性、益处和危害。
在这项混合方法研究中，对HoPES3干预组的11名德国全科医生和12名医疗助理进行了电话访谈，并采用内容分析方法进行分析。此外，要求全科医生在每次进行精神病史询问后填写一份问卷。对14名全科医生的141份问卷进行了描述性分析。
全科医生认为精神病史对患者非常/相当有帮助的占27%（n = 38），认为非常/相当有压力的占2%（n = 3）。访谈表明，全科医生发现讨论精神病史比预期更容易。全科医生和医疗助理发现一个困难在于，许多患者将精神性与宗教或教会联系起来，并以惊讶或拒绝的态度做出反应。对患者的益处在于有机会谈论非医疗话题，以及增强对自身资源的认识。对全科医生的益处主要与获得信息和加强医患关系有关。
全科医疗中的精神病史询问有潜力揭示关于患者生活的重要信息，并改善医患关系。必须考虑并解决本研究中确定的实施障碍。
