Havyer Rachel D, Wiste Rachel M, Ingram Cory, Ridgeway Jennifer L, Yost Kathleen J
Division of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, Rochester, Minnesota, USA.
Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA.
Palliat Med Rep. 2025 Apr 29;6(1):215-222. doi: 10.1089/pmr.2024.0110. eCollection 2025.
Collaborative methods are necessary to meet patient palliative care (PC) needs because of the inadequate supply of PC specialists.
This study aimed to conduct a needs assessment and determine primary care, emergency, and hospital physicians' general attitudes about primary PCs, confidence in managing common PC scenarios, and preferences for interaction with specialty PCs.
A sequential mixed-methods study design was used, whereby individual qualitative interviews informed the content of a quantitative survey. Semistructured telephone interviews were conducted by a member of the study team with expertise in qualitative research methods.
SETTING/SUBJECTS: The quantitative survey, delivered to primary care, emergency, and hospital physicians across four distinct geographic locations of a large health system, solicited impressions on common clinical PC scenarios that might pose challenges.
Survey data included demographic information, clinician confidence levels, preferences for support in managing PC scenarios, and likelihood to refer to PC.
The quantitative survey was completed by 126 physicians (response rate, 13.9%). Overall mean (standard deviation) confidence levels were lowest for a scenario about handling pain (5.57 [2.35] out of 10) and highest for goals-of-care conversations with the patient (7.80 [2.02]). Spearman correlations between mean confidence and likelihood to refer to PC demonstrated weak to moderate inverse correlations. Respondents with previous training in PC had higher mean confidence in managing symptoms and goals-of-care conversations.
Continuing efforts are needed to help improve physicians' confidence in primary PC skills and develop innovative methods to provide collaborative support of specialty PCs across various specialties and PC needs.
由于姑息治疗（PC）专家供应不足，采用协作方法对于满足患者的姑息治疗需求很有必要。
本研究旨在进行需求评估，并确定初级保健医生、急诊科医生和医院医生对初级姑息治疗的总体态度、处理常见姑息治疗情况的信心以及与专科姑息治疗互动的偏好。
采用顺序混合方法研究设计，通过个体定性访谈为定量调查的内容提供信息。由研究团队中具有定性研究方法专业知识的成员进行半结构化电话访谈。
设置/对象：向一个大型医疗系统四个不同地理位置的初级保健医生、急诊科医生和医院医生进行定量调查，征求他们对可能带来挑战的常见临床姑息治疗情况的看法。
调查数据包括人口统计学信息、临床医生的信心水平、处理姑息治疗情况时对支持的偏好以及转诊至姑息治疗的可能性。
126名医生完成了定量调查（回复率为13.9%）。对于处理疼痛的情况，总体平均（标准差）信心水平最低（10分制中为5.57[2.35]），而与患者进行护理目标对话的信心水平最高（7.80[2.02]）。平均信心与转诊至姑息治疗可能性之间的斯皮尔曼相关性显示出弱到中度的负相关。接受过姑息治疗先前培训的受访者在管理症状和护理目标对话方面的平均信心更高。
需要持续努力来帮助提高医生对初级姑息治疗技能的信心，并开发创新方法，以在各个专科和姑息治疗需求方面为专科姑息治疗提供协作支持。
