General Practice Research Unit, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.
Unit for Palliative Care and Chemotherapy Treatment, Oncology Department, Møre og Romsdal Hospital Trust, Kristiansund Hospital, Norway.
Scand J Prim Health Care. 2024 Jun;42(2):254-265. doi: 10.1080/02813432.2024.2306241. Epub 2024 Jan 30.
Demographic changes, the evolvement of modern medicine and new treatments for severe diseases, increase the need for palliative care services. Palliative care includes all patients with life-limiting conditions, irrespective of diagnosis. In Norway, palliative care rests on a decentralised model where patient care can be delivered close to the patient's home, and the Norwegian guideline for palliative care describes a model of care resting on extensive collaboration. Previous research suggests that this guideline is not well implemented among general practitioners (GPs). In this study, we aim to investigate barriers to GPs' participation in palliative care and implementation of the guideline.
We interviewed 25 GPs in four focus groups guided by a semi-structured interview guide. The interviews were recorded and transcribed verbatim. Data were analysed qualitatively with reflexive thematic analysis.
We identified four main themes as barriers to GPs' participation in palliative care and to implementation of the guideline: (1) different established local cultures and practices of palliative care, (2) discontinuity of the GP-patient relationship, (3) unclear clinical handover and information gaps and (4) a mismatch between the guideline and everyday general practice.
Significant structural and individual barriers to GPs' participation in palliative care exist, which hamper the implementation of the guideline. GPs should be involved as stakeholders when guidelines involving them are created. Introduction of new professionals in primary care needs to be actively managed to avoid inappropriate collaborative practices. Continuity of the GP-patient relationship must be maintained throughout severe illness and at end-of-life.
人口结构变化、现代医学的发展以及严重疾病的新疗法，增加了对姑息治疗服务的需求。姑息治疗涵盖了所有患有生命有限疾病的患者，无论其诊断如何。在挪威，姑息治疗基于分散模式，患者护理可以在靠近患者家庭的地方进行，挪威姑息治疗指南描述了一种基于广泛合作的护理模式。先前的研究表明，该指南在全科医生（GP）中的实施情况并不理想。在这项研究中，我们旨在调查全科医生参与姑息治疗和实施该指南的障碍。
我们在四个焦点小组中对 25 名全科医生进行了访谈，访谈由半结构化访谈指南指导。访谈进行了录音并逐字记录。数据采用反思性主题分析进行定性分析。
我们确定了四个主要主题，这些主题是全科医生参与姑息治疗和实施该指南的障碍：（1）不同的既定姑息治疗当地文化和实践，（2）全科医生与患者关系的不连续性，（3）临床交接不明确和信息差距，以及（4）指南与日常全科实践之间不匹配。
全科医生参与姑息治疗存在重大的结构性和个体障碍，这阻碍了该指南的实施。在制定涉及全科医生的指南时，应让全科医生作为利益相关者参与。在引入新的初级保健专业人员时，需要积极管理，以避免不当的合作实践。全科医生与患者的关系必须在严重疾病和生命末期保持连续性。
