de Vries Sita, Pijnappel Laury, Vervoort Sigrid, van der Linden Yvette, Teunissen Saskia, de Graaf Everlien
Center of Expertise in Palliative Care, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
General practice and Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
Am J Hosp Palliat Care. 2025 Mar;42(3):300-308. doi: 10.1177/10499091241261025. Epub 2024 Jun 18.
Insight into patients' personal values, wishes, and needs (VWN) by clinicians is essential to guide appropriate palliative care. To gain insight into the exploration and monitoring of the VWN of patients with advanced cancer during the illness trajectory by hospital oncology clinicians. A generic qualitative study was conducted from February 2022 to July 2022. Specialized nurses, nurse practitioners and medical specialists (in training) providing care to adult patients with advanced cancer were recruited at an outpatient clinic in a Dutch academic hospital. Data were collected using in-depth semi-structured interviews and participatory observations of outpatient clinic consultations. Data were analyzed collaboratively by two researchers using thematic analysis. Eleven clinicians, aged 33-64, 8 females, participated; 7 interviews and 13 observations were conducted. How clinicians explored and monitored patients' VWN was based on their opinions, originating from the clinicians' personal values and work experiences. These were influenced by the local collaboration. Three key opinions were identified: (1) providing safety, (2) supporting medical decision-making, and (3) ensuring alignment. Individual clinicians' approaches varied. The alignment of care and treatment with the patient's VWN was observed to be limited. Clinicians acknowledged the importance of exploring and monitoring patients' VWN but lacked a systematic approach in discussing these topics. Patients should be actively engaged in communication regarding their VWN rather than primarily being provided with medical information. Patient-Reported Outcome Measures may be beneficial in facilitating communication regarding the patient's VWN and could improve appropriate palliative care in hospital cancer care.
临床医生了解患者的个人价值观、愿望和需求（VWN）对于指导适当的姑息治疗至关重要。目的是了解医院肿瘤临床医生在疾病轨迹中对晚期癌症患者的VWN进行探索和监测的情况。于2022年2月至2022年7月进行了一项一般性定性研究。在一家荷兰学术医院的门诊诊所招募了为成年晚期癌症患者提供护理的专科护士、执业护士和医学专家（培训中）。通过深入的半结构化访谈和门诊会诊的参与性观察收集数据。由两名研究人员使用主题分析法对数据进行协作分析。11名年龄在33 - 64岁之间的临床医生参与，其中8名女性；进行了7次访谈和13次观察。临床医生探索和监测患者VWN的方式基于他们的观点，这些观点源于临床医生的个人价值观和工作经验。这些受到当地协作的影响。确定了三个关键观点：（1）提供安全保障，（2）支持医疗决策，（3）确保一致性。个体临床医生的方法各不相同。观察到护理和治疗与患者VWN的一致性有限。临床医生承认探索和监测患者VWN的重要性，但在讨论这些话题时缺乏系统的方法。患者应积极参与关于其VWN的沟通，而不是主要被提供医疗信息。患者报告结局测量可能有助于促进关于患者VWN的沟通，并可改善医院癌症护理中的适当姑息治疗。
