Marx Gabriella, Mallon Tina, Stanze Henrikje, Zimansky Manuel, Schneider Nils, Nauck Friedemann, Scherer Martin, Pohontsch Nadine
Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg, 20246, Germany.
Department 3, Hochschule Bremen, City University of Applied Sciences, Bremen, Germany.
BMC Prim Care. 2025 Feb 22;26(1):52. doi: 10.1186/s12875-025-02750-z.
Patients suffering from progressive non-oncologic chronic diseases are primarily treated in primary care. Early integration of palliative care (PC) can improve patients' quality of life and reduce burdensome physical symptoms. To guide interprofessional counselling between GPs and specialist palliative home care teams, we developed an aide memoire for patients diagnosed with advanced non-oncological chronic diseases, the KOPAL conversation guide, as part of the KOPAL trial. The aim of this study was to ensure the conversation guide covers all relevant care aspects in order to reveal individual gaps and needs in healthcare.
We conducted three focus groups including four patients, seven health care providers, and five stakeholders. During each group, a draft of the conversation guide was discussed, revised, and consented from the respective perspectives.
The final KOPAL conversation guide contains eight key topics: living with the illness, physical, emotional, personal, and social situation, information and communication, control and autonomy, emergency management. Each topic refers to a number of related subtopics listed in each respective thematic section. The conversation should start with the introductory question referring to the patient's current well-being. At the end, patients are asked to state their primary concern based on the conversation.
The KOPAL conversation guide is a broad evaluation and communication tool. It covers potential PC needs of non-oncological patients and provides a basis for interprofessional case planning, and counselling. Applying the guide may help to bridge gaps in communication between general and specialist PC professionals as well as between professionals and patients.
患有进行性非肿瘤慢性疾病的患者主要在初级保健机构接受治疗。早期整合姑息治疗（PC）可以提高患者的生活质量并减轻令人负担的身体症状。为指导全科医生（GPs）与专科姑息家庭护理团队之间的跨专业咨询，我们制定了一份针对被诊断患有晚期非肿瘤慢性疾病患者的备忘单，即KOPAL对话指南，作为KOPAL试验的一部分。本研究的目的是确保该对话指南涵盖所有相关护理方面，以揭示医疗保健中的个体差距和需求。
我们进行了三个焦点小组讨论，包括四名患者、七名医疗保健提供者和五名利益相关者。在每个小组讨论中，从各自的角度对对话指南草案进行了讨论、修订并达成共识。
最终的KOPAL对话指南包含八个关键主题：与疾病共存、身体、情感、个人和社会状况、信息与沟通、控制与自主权、应急管理。每个主题都涉及在各自主题部分列出的一些相关子主题。对话应从提及患者当前健康状况的介绍性问题开始。最后，要求患者根据对话陈述其主要关切。
KOPAL对话指南是一种广泛的评估和沟通工具。它涵盖了非肿瘤患者潜在的姑息治疗需求，并为跨专业病例规划和咨询提供了基础。应用该指南可能有助于弥合普通和专科姑息治疗专业人员之间以及专业人员与患者之间的沟通差距。
