Holdsworth Rebecca, Alberti Hugh, Burford Bryan, Farrington Emma, Vance Gillian
Newcastle University, Newcastle upon Tyne, UK.
National Institute for Health and Care Research, London, UK.
BMC Med Educ. 2024 Dec 23;24(1):1520. doi: 10.1186/s12909-024-06570-0.
The COVID-19 pandemic led to an increase in numbers of patients dying at home in the UK, meaning that general practitioners (GPs) were exposed to more patient death than would be pre-COVID. This project aimed to gain insight into GP trainees' experiences of patient death between March and July 2020. This insight can inform support for GPs, leading to improved wellbeing, workforce retention and ultimately, better patient-centred care.
Interpretative Phenomenological Analysis (IPA) of semi-structured interviews was used to explore GP trainees' experiences of patient death in one region of England.
Seven trainees, two male and five female, participated. They were working in both rural and urban community settings and were at different stages of GP training. Group experiential themes related to heightened emotional responses to patient death, managing uncertainty and the increased salience of relationships. Most appreciated positive teamworking and solidarity, though some had felt isolated within their surgery and wider community. There were some unforeseen positive experiences of individual and organisational healthcare changes, including a perceived new appreciation for the NHS workforce equality, diversity and inclusion (EDI) by actions to identify and reduce occupational hazards to at-risk healthcare staff. There were potential effects on career choice with participants feeling that changes during COVID-19 offered new flexibility in working arrangements and opportunity to sub-specialise within GP.
More support to help navigate the amplified emotional responses to managing dying and death in the community is needed. Some experiences, particularly around managing uncertainty, can cause moral injury if not managed in a safe and supportive environment.
新冠疫情导致英国在家中死亡的患者数量增加，这意味着全科医生（GP）面临的患者死亡情况比疫情前更多。该项目旨在深入了解2020年3月至7月期间全科医生培训学员对患者死亡的经历。这些见解可为支持全科医生提供参考，从而改善其身心健康、提高劳动力留存率，并最终提供更好的以患者为中心的护理。
采用对半结构化访谈的解释现象学分析（IPA）来探索英格兰一个地区全科医生培训学员对患者死亡的经历。
七名学员参与了研究，其中两名男性，五名女性。他们在农村和城市社区环境中工作，处于全科医生培训的不同阶段。群体体验主题包括对患者死亡的情绪反应加剧、应对不确定性以及人际关系的重要性增加。大多数人赞赏积极的团队合作和团结，尽管有些人在诊所和更广泛的社区中感到孤立。在个人和组织层面的医疗保健变革中出现了一些意外的积极经历，包括通过采取行动识别和减少对高危医护人员的职业危害，人们对国民保健服务体系（NHS）劳动力平等、多样性和包容性（EDI）有了新的认识。这对职业选择可能产生影响，参与者认为新冠疫情期间的变化为工作安排提供了新的灵活性，并为在全科医生领域进行亚专业发展提供了机会。
需要更多支持来帮助应对在社区中处理死亡和临终问题时放大的情绪反应。如果不在安全和支持性的环境中处理，一些经历，特别是围绕应对不确定性的经历，可能会导致道德伤害。
