Institute of General Practice, Friedrich-Alexander-University Erlangen-Nürnberg, University Hospital Erlangen, Universitätsstr. 29, 91054, Erlangen, Germany.
Lutheran University of Applied Sciences, Nürnberg, Germany.
BMC Palliat Care. 2024 Aug 3;23(1):197. doi: 10.1186/s12904-024-01529-w.
In Germany, general practitioners play a pivotal role in palliative care provision. Caring for patients with palliative care needs can be a burden for general practitioners, highlighting the importance of self-care and mental health support. This study aimed to explore the role of palliative care in general practitioners' daily work, the stressors they experience, their coping mechanisms, and the potential benefits of Advance Care Planning in this context.
An exploratory approach was employed, combining a short quantitative survey with qualitative interviews. The analysis was based on a structuring qualitative content analysis, following a deductive-inductive procedure and integrating the Stress-Strain Model and Lazarus' Transactional Model of Stress and Coping. We recruited eleven general practitioners to take part in the study.
General practitioners viewed palliative care as integral to their practice but faced challenges such as time constraints and perceived expertise gaps. Societal taboos often hindered conversations on the topic of death. Most general practitioners waited for their patients to initiate the topic. Some general practitioners viewed aspects of palliative care as potentially distressing. They used problem-focused (avoiding negative stressors, structuring their daily schedules) and emotion-focused (discussions with colleagues) coping strategies. Still, general practitioners indicated a desire for specific psychological support options. Advance Care Planning, though relatively unfamiliar, was acknowledged as valuable for end-of-life conversations.
Palliative care can be associated with negative psychological stress for general practitioners, often coming from external factors. Despite individual coping strategies in place, it is advisable to explore concepts for professional psychological relief.
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在德国，全科医生在提供姑息治疗方面发挥着关键作用。照顾有姑息治疗需求的患者可能会给全科医生带来负担，这凸显了自我保健和心理健康支持的重要性。本研究旨在探讨姑息治疗在全科医生日常工作中的作用、他们所经历的压力源、他们的应对机制，以及在这种情况下预先医疗指示的潜在益处。
采用探索性方法，将简短的定量调查与定性访谈相结合。分析基于结构定性内容分析，采用演绎-归纳程序，并整合压力-应变模型和 Lazarus 的应激与应对的交易模型。我们招募了 11 名全科医生参与研究。
全科医生认为姑息治疗是其实践的重要组成部分，但面临时间限制和感知专业知识差距等挑战。社会禁忌常常阻碍了关于死亡话题的讨论。大多数全科医生等待他们的患者主动提出这个话题。一些全科医生认为姑息治疗的某些方面可能令人痛苦。他们使用问题焦点（避免负面压力源，安排日常日程）和情绪焦点（与同事讨论）的应对策略。尽管如此，全科医生表示希望获得特定的心理支持选择。预先医疗指示虽然相对不熟悉，但被认为对临终谈话有价值。
姑息治疗可能会给全科医生带来负面的心理压力，这些压力通常来自外部因素。尽管存在个人应对策略，但有必要探讨专业心理缓解的概念。
