Department of Nursing, Umeå University, 901 87 Umeå, Sweden.
Department of Oncology and Pathology, Karolinska Institute, 171 77 Stockholm, Sweden.
Int J Environ Res Public Health. 2022 Dec 2;19(23):16134. doi: 10.3390/ijerph192316134.
Developments in cancer care have resulted in improved survival and quality of life. Integration of acute and palliative cancer care is desirable, but not always achieved. Fragmented care is associated with sub-optimal communication and collaboration, resulting in unnecessary care transitions. The aim of this study was to explore how health care professionals, from both acute and palliative care, perceive clinical decision-making when caring for patients undergoing active cancer treatment in parallel with specialized palliative care at home.
Qualitative explorative design, using online focus-group interviews, based on patient-cases, among health care professionals (physicians and nurses) and Framework Analysis.
Six online focus-group interviews were performed. Few signs of systematic integration were found, risking fragmented care, and putting the patients in a vulnerable situation. Different aspects of uncertainty related to mandates and goals-of-care impacted clinical decision-making. Organizational factors appeared to hinder mutual clinical decision-making as well as the uncertainty related to responsibilities. These uncertainties seemed to be a barrier to timely end-of-life conversations and clinical decisions on optimal care, for example, the appropriateness of transfer to acute care.
Lack of integration between acute and palliative care have negative consequences for patients (fragmented care), health care professionals (ethical stress), and the health care system (inadequate use of resources).
癌症护理的发展带来了生存和生活质量的提高。急性和姑息治疗的整合是理想的，但并不总是能够实现。分散的护理与沟通和协作不理想有关，导致不必要的护理过渡。本研究旨在探讨在为同时接受积极癌症治疗和在家接受专门姑息治疗的患者提供护理时，来自急性和姑息治疗的医疗保健专业人员如何看待临床决策。
定性探索性设计，使用基于患者病例的在线焦点小组访谈，参与者为医疗保健专业人员（医生和护士），并采用框架分析。
进行了六次在线焦点小组访谈。几乎没有发现系统整合的迹象，这存在护理分散的风险，并使患者处于脆弱的境地。与任务和治疗目标相关的不同方面的不确定性影响了临床决策。组织因素似乎阻碍了相互的临床决策以及与责任相关的不确定性。这些不确定性似乎是及时进行临终对话和关于最佳护理的临床决策的障碍，例如，是否适合转至急性护理。
急性和姑息治疗之间缺乏整合对患者（护理分散）、医疗保健专业人员（伦理压力）和医疗保健系统（资源利用不足）都有负面影响。
