The Research Unit for General Practice and Section for General Practice, University of Copenhagen, Copenhagen, Denmark.
Palliative Care Unit, Copenhagen University Hospital, Hvidovre, Copenhagen, Denmark.
BMC Prim Care. 2023 Mar 23;24(1):77. doi: 10.1186/s12875-023-02038-0.
Many elderly people wish to die at home but end up dying at the hospital. If the patient wishes to die at home, palliative care provided by General Practitioners (GPs) may increase the chance of dying at home, however, there is a lack of knowledge on how GPs should provide palliative care. We aimed to identify roles, tasks and approaches of GPs enabling palliative care, by exploring the experiences of GPs, other healthcare professionals, patients, and relatives through a systematic review of the qualitative literature.
We searched PubMed, EMBASE, PsycINFO, Web of Science, and CINAHL in March 2022. Thematic analysis was used for synthesizing the results.
Four thousand five hundred sixty three unique records were retrieved, and 12 studies were included for review. Of these, ten were interview or focus group studies and two were survey studies with additional open-ended questions. Only qualitative findings from the studies were used in synthesizing the results. Thematic analysis produced four main themes describing the roles, tasks and approaches of GPs enabling palliative care to increase the chance for patients to die at home. GPs can support patients in the final phases of life by applying a holistic, patient-centred, and proactive approach to palliative care and by having sufficient education and training. Furthermore, the palliative care consultation should include symptom management, handling psychosocial and spiritual needs, maintaining a fragile balance, and proper communication with the patient. Lastly, GPs must address several palliative care elements surrounding the consultation including initiating the palliative care, being available, being the team coordinator/collaborator, providing continuous care and having sufficient knowledge about the patient.
The roles, tasks and approaches of the GPs enabling palliative care include being aware of elements in the palliative care consultation and elements surrounding the consultation and by having sufficient education and training and a broad, proactive, and patient-centred approach.
许多老年人希望在家中离世，但最终却在医院去世。如果患者希望在家中离世，全科医生（GP）提供的姑息治疗可能会增加在家中离世的机会，然而，对于 GP 应该如何提供姑息治疗，人们知之甚少。我们旨在通过系统回顾定性文献，确定 GP 提供姑息治疗的角色、任务和方法，通过探索 GP、其他医疗保健专业人员、患者和亲属的经验。
我们于 2022 年 3 月在 PubMed、EMBASE、PsycINFO、Web of Science 和 CINAHL 中进行了检索。使用主题分析对结果进行综合。
共检索到 4563 条独特记录，纳入了 12 项研究进行综述。其中，10 项为访谈或焦点小组研究，2 项为调查研究，并附有开放性问题。仅使用研究中的定性发现来综合结果。主题分析产生了四个主要主题，描述了 GP 提供姑息治疗以增加患者在家中离世机会的角色、任务和方法。GP 可以通过对姑息治疗采取整体、以患者为中心、主动的方法，并接受充分的教育和培训，来支持生命末期的患者。此外，姑息治疗咨询应包括症状管理、处理心理社会和精神需求、维持脆弱的平衡以及与患者进行适当的沟通。最后，GP 必须解决姑息治疗咨询中涉及的几个方面，包括启动姑息治疗、随时待命、担任团队协调员/合作者、提供持续护理以及对患者有足够的了解。
GP 提供姑息治疗的角色、任务和方法包括了解姑息治疗咨询中的各个方面和咨询周围的各个方面，接受充分的教育和培训，采取广泛、主动和以患者为中心的方法。
