“从一开始就那样想”：对接受姑息治疗的人群进行逐渐减药决策——对医疗保健专业人员观点的定性探索。
"Starting to think that way from the start": approaching deprescribing decision-making for people accessing palliative care - a qualitative exploration of healthcare professionals views.
机构信息
School of Pharmacy, Newcastle University, King George VI Building, Newcastle upon Tyne, NE1 7RU, UK.
Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, NE2 4BN, UK.
出版信息
BMC Palliat Care. 2024 Sep 6;23(1):221. doi: 10.1186/s12904-024-01523-2.
BACKGROUND
Deprescribing has been defined as the planned process of reducing or stopping medications that may no longer be beneficial or are causing harm, with the goal of reducing medication burden while improving patient quality of life. At present, little is known about the specific challenges of decision-making to support deprescribing for patients who are accessing palliative care. By exploring the perspectives of healthcare professionals, this qualitative study aimed to address this gap, and explore the challenges of, and potential solutions to, making decisions about deprescribing in a palliative care context.
METHODS
Semi-structured interviews were conducted with healthcare professionals in-person or via video call, between August 2022 - January 2023. Perspectives on approaches to deprescribing in palliative care; when and how they might deprescribe; and the role of carers and family members within this process were discussed. Interviews were audio-recorded and transcribed verbatim. Reflexive thematic analysis enabled the development of themes. QSR NVivo (Version 12) facilitated data management. Ethical approval was obtained from the NHS Health Research Authority (ref 305394).
RESULTS
Twenty healthcare professionals were interviewed, including: medical consultants, nurses, specialist pharmacists, and general practitioners (GPs). Participants described the importance of deprescribing decision-making, and that it should be a considered, proactive, and planned process. Three themes were developed from the data, which centred on: (1) professional attitudes, competency and responsibility towards deprescribing; (2) changing the culture of deprescribing; and (3) involving the patient and family/caregivers in deprescribing decision-making.
CONCLUSIONS
This study sought to explore the perspectives of healthcare professionals with responsibility for making deprescribing decisions with people accessing palliative care services. A range of healthcare professionals identified the importance of supporting decision-making in deprescribing, so it becomes a proactive process within a patient's care journey, rather than a reactive consequence. Future work should explore how healthcare professionals, patients and their family can be supported in the shared decision-making processes of deprescribing.
TRIAL REGISTRATION
Ethical approval was obtained from the NHS Health Research Authority (ref 305394).
背景
去处方化被定义为有计划地减少或停止那些可能不再有益或造成伤害的药物的过程，目的是减轻药物负担，同时提高患者的生活质量。目前，人们对姑息治疗患者决策支持去处方化的具体挑战知之甚少。通过探索医疗保健专业人员的观点，这项定性研究旨在解决这一差距，并探讨在姑息治疗环境中做出去处方化决策的挑战以及潜在的解决方案。
方法
2022 年 8 月至 2023 年 1 月期间，通过面对面或视频通话的方式对医疗保健专业人员进行了半结构化访谈。讨论了姑息治疗中去处方化的方法；何时以及如何去处方化；以及在这个过程中照顾者和家庭成员的角色。采访进行了录音，并逐字记录下来。反思性主题分析使主题得以发展。QSR NVivo（版本 12）促进了数据管理。英国国民保健系统健康研究管理局（编号 305394）批准了伦理审查。
结果
共采访了 20 名医疗保健专业人员，包括：医学顾问、护士、专科药剂师和全科医生（GP）。参与者描述了去处方化决策的重要性，认为这应该是一个经过深思熟虑、积极主动和有计划的过程。从数据中得出了三个主题，分别是：（1）专业人员对去处方化的态度、能力和责任感；（2）改变去处方化的文化；（3）让患者及其家属/照顾者参与去处方化决策。
结论
本研究旨在探讨负责为接受姑息治疗服务的患者做出去处方化决策的医疗保健专业人员的观点。一系列医疗保健专业人员确定了支持决策支持去处方化的重要性，以便它成为患者护理旅程中的一个积极主动的过程，而不是反应性的后果。未来的工作应该探讨如何支持医疗保健专业人员、患者及其家属在共同决策的去处方化过程中。
试验注册
英国国民保健系统健康研究管理局（编号 305394）批准了伦理审查。
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