多发性骨髓瘤患者及其照护者的重病沟通中的跨学科协作 - 一项定性研究。
Interdisciplinary collaboration in serious illness conversations in patients with multiple myeloma and caregivers - a qualitative study.
机构信息
Department of Hematology, Copenhagen University Hospital, Blegdamsvej 9, Rigshospitalet, Copenhagen, 2100, Denmark.
Cancer Survivorship and Treatment Late Effects (CASTLE), Department of Oncology, Copenhagen University, Blegdamsvej 58, Rigshospitalet, Copenhagen, 2100, Denmark.
出版信息
BMC Palliat Care. 2023 Jul 13;22(1):93. doi: 10.1186/s12904-023-01221-5.
BACKGROUND
There is growing evidence that conversations between healthcare professionals and patients with serious illness can improve the quality of end-of-life cancer care. Yet, there is lack of insight into how different healthcare professions collaborate to deliver serious illness communication, as well as patients' and caregivers' perceptions of this collaboration between the nurse and physician. This study explores the interdisciplinary collaboration between nurses and physicians in serious illness conversations with patients diagnosed with multiple myeloma and their caregivers.
METHODS
Eleven dyadic interviews were conducted with 22 patients and caregivers, and two focus group interviews involving four nurses and the other with four physicians. Data analysis and reporting were conducted using reflexive thematic analysis within phenomenological epistemology.
RESULTS
The interdisciplinary collaboration was characterized by three main themes: (1) Importance of relationships, (2) Complementary perspectives, and (3) The common goal.
CONCLUSION
This study highlights the importance of interdisciplinarity in serious illness conversations as it enhances the use of existential and descriptive language when addressing medical, holistic, and existential issues. The use of broader language also reflects that interdisciplinary interaction strengthens the expertise of each professional involved in patient care. Through interdisciplinary collaboration, the preferences, hopes, and values of the patient and caregiver can be integrated into the treatment plan, which is key in providing the delivery of optimal care. To promote cohesive and coordinated collaboration, organizational changes are recommended such as supporting continuity in patient-healthcare professional relationships, providing interdisciplinary training, and allocating time for pre-conversation preparation and post-conversation debriefing.
背景
越来越多的证据表明，医护人员与重病患者之间的对话可以提高癌症临终关怀的质量。然而，人们对不同医疗保健专业如何协作进行重病沟通，以及患者和护理人员对护士和医生之间这种协作的看法缺乏了解。本研究探讨了护士和医生在多发性骨髓瘤患者及其护理人员的重病对话中的跨学科协作。
方法
对 22 名患者和护理人员进行了 11 次双人访谈，对 4 名护士和另外 4 名医生进行了 2 次焦点小组访谈。数据分析和报告采用现象学认识论中的反思性主题分析进行。
结果
跨学科协作的特点是三个主要主题：（1）关系的重要性，（2）互补的观点，（3）共同目标。
结论
本研究强调了在重病对话中跨学科合作的重要性，因为它增强了在解决医学、整体和存在问题时使用存在主义和描述性语言的能力。更广泛的语言的使用也反映了跨学科互动增强了参与患者护理的每个专业人员的专业知识。通过跨学科合作，可以将患者和护理人员的偏好、希望和价值观融入治疗计划中，这是提供最佳护理的关键。为了促进凝聚力和协调的合作，建议进行组织变革，例如支持患者-医护人员关系的连续性，提供跨学科培训，以及为预对话准备和对话后汇报分配时间。
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