Department of Oncology, Møre and Romsdal Hospital Trust, Ålesund, Norway.
Department for Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway.
BMC Prim Care. 2024 Jul 6;25(1):245. doi: 10.1186/s12875-024-02499-x.
Many cancer patients prefer to receive palliative treatment at home, as it allows them to be in a familiar and comfortable environment. Integrating Advance Care Planning (ACP) into routine practice in primary healthcare helps patients and their relatives prepare for end-of-life (EoL) care in accordance with patients' preferences. This includes the option to spend their final days at home if desired. The aim of this study was to gain insights from experiences of advanced seriously ill cancer patients at home while receiving palliative treatment and being engaged in ACP within primary healthcare settings.
This study employed a qualitative design, utilizing individual, semi-structured interviews that were analysed through reflexive thematic analysis, employing an abductive approach with a latent-level focus. The study included interviews with 12 participants with cancer who were receiving palliative care, had an estimated lifetime under 3 months, and had undergone an organized ACP approach in primary healthcare, documented with a palliative plan.
Participants emphasized the importance of (1) Preserving normality at home, maintaining a sense of routine, comfort, and familiarity in the face of present and future challenges. The top obstacles for success identified by participants included (1a) The challenge of deterioration and the dual aspects of (1b) The value and burden of family caregivers. Cancer treatment placed a significant demand on patients due to side effects. Family caregivers played a crucial role for participants, providing support in daily life and serving as a key factor in the overall decision to which extend they are able to involve in support and care at home in the future. (2) Compassionate health care personnel (HCP) made a difference by fostering a culture of understanding participants' concerns, fears, and preferences, which was a key element that built and maintained trust for the participants. (3) Preparing for the future, especially EoL discussions initiated by healthcare personnel, was deemed important but, at times, uncomfortable for participants as it confronted them with reality. Guidance from ACP provided them with a sense of certainty and control.
Preserving normality at home, along with the desire to stay at home for as long as possible, is a crucial goal for advanced cancer patients. Consistent professional communication and care in primary healthcare play a key role in building and maintaining trust, as well as fostering a sense of certainty and control for the participants.
许多癌症患者更喜欢在家中接受姑息治疗，因为这样可以让他们身处熟悉和舒适的环境中。在初级保健中整合预先医疗照护计划（ACP）有助于患者及其家属根据患者的偏好为临终关怀做准备。这包括如果患者希望的话，选择在家中度过最后几天的选项。本研究的目的是了解在家中接受姑息治疗并在初级保健环境中参与 ACP 的晚期重病癌症患者的体验。
本研究采用定性设计，使用个体半结构化访谈，通过反思性主题分析进行分析，采用具有潜在重点的归纳方法。该研究包括 12 名接受姑息治疗、预计寿命不足 3 个月且在初级保健中接受过有组织的 ACP 方法并记录姑息治疗计划的癌症患者的访谈。
参与者强调了以下几个方面的重要性：（1）在家中保持正常状态，面对现在和未来的挑战时保持日常生活的常规、舒适和熟悉感。参与者确定的成功的主要障碍包括（1a）恶化的挑战和（1b）家庭照顾者的价值和负担的双重方面。癌症治疗由于副作用给患者带来了巨大的压力。家庭照顾者对参与者来说至关重要，他们在日常生活中提供支持，是参与者决定在未来能够在家中提供多少支持和护理的关键因素。（2）富有同情心的医护人员通过培养理解参与者的担忧、恐惧和偏好的文化，从而产生了影响，这是建立和维持参与者信任的关键因素。（3）为未来做准备，特别是医护人员发起的临终讨论，虽然对参与者来说很重要，但有时也很不舒服，因为这让他们直面现实。ACP 提供的指导让他们感到确定和掌控。
在家中保持正常状态，以及尽可能长时间地留在家里的愿望，是晚期癌症患者的一个关键目标。初级保健中持续的专业沟通和护理在建立和维持信任以及为参与者提供确定感和掌控感方面发挥着关键作用。
