Jones Rachelle, Dale Jeremy, MacArtney John
Warwick Medical School, University of Warwick, Coventry, UK
Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry, UK.
BJGP Open. 2023 Jun 27;7(2). doi: 10.3399/BJGPO.2022.0159. Print 2023 Jun.
GPs in the UK will face increased palliative care demands in the coming years. Understanding what makes providing palliative care difficult for GPs is an important step to planning future services, but currently there is an absence of synthesised literature addressing this area.
To identify the range of issues that affect GPs' provision of palliative care.
DESIGN & SETTING: A qualitative systematic review and thematic synthesis of studies exploring GPs' experiences of providing palliative care in the UK.
Four databases (MEDLINE, Embase, Web of Science, and CINAHL [Cumulated Index to Nursing and Allied Health Literature]) were searched on 1 June 2022 to identify relevant primary qualitative literature published between 2008 and 2022.
Twelve articles were included in the review. The following four themes were identified that affect GPs' experiences of providing palliative care: lack of resources to support palliative care provision; fragmented multidisciplinary team (MDT) approach; challenging communication with patients and carers; and inadequate training to address the complexities of palliative care. Pressures caused by increasing workloads and a lack of staffing combined with difficulty accessing specialist teams impeded GPs' provision of palliative care. Further challenges were deficiencies in GP training, and a lack of patient understanding or unwillingness to engage in palliative care discussions.
A multifaceted approach focusing on increased resources, improved training, and a seamless interface between services, including improved access to specialist palliative teams when necessary, is needed to address the difficulties that GPs face in palliative care. Regular in-house MDT discussion of palliative cases and exploration of community resources could generate a supportive environment for GPs.
英国的全科医生在未来几年将面临日益增加的姑息治疗需求。了解导致全科医生提供姑息治疗困难的因素是规划未来服务的重要一步，但目前缺乏针对该领域的综合文献。
确定影响全科医生提供姑息治疗的一系列问题。
对探索英国全科医生提供姑息治疗经历的研究进行定性系统评价和主题综合分析。
于2022年6月1日检索了四个数据库（MEDLINE、Embase、科学引文索引和护理学与健康相关文献累积索引），以识别2008年至2022年期间发表的相关定性原始文献。
该评价纳入了12篇文章。确定了以下影响全科医生提供姑息治疗经历的四个主题：支持姑息治疗提供的资源不足；多学科团队方法分散；与患者及护理人员的沟通具有挑战性；以及应对姑息治疗复杂性的培训不足。工作量增加和人员短缺造成的压力，加上难以联系到专科团队，阻碍了全科医生提供姑息治疗。进一步的挑战包括全科医生培训存在缺陷，以及患者缺乏理解或不愿参与姑息治疗讨论。
需要采取多方面的方法，重点是增加资源、改进培训以及服务之间的无缝衔接，包括在必要时改善获得专科姑息治疗团队的机会，以解决全科医生在姑息治疗中面临的困难。定期在内部进行多学科团队对姑息治疗病例的讨论并探索社区资源，可以为全科医生营造一个支持性的环境。
