Field D
Centre for Cancer and Palliative Care Studies Care Studies, Institute of Cancer Research/Royal Marsden NHS Trust, London, UK.
Soc Sci Med. 1998 May;46(9):1111-20. doi: 10.1016/s0277-9536(97)10041-7.
In modern Britain the majority of terminal care occurs in people's own homes and many dying people and their carers would prefer the death itself to occur in the home. The quality of terminal care in the home and the possibility of a home death depend to a great extent upon the care provided by GPs and community nurses. This paper reports on GPs' experiences of caring for dying people and their attitudes towards such work. It is based on unstructured interviews with 25 GPs who graduated from the 1979 entry cohort to the University of Leicester medical school. The respondents were recruited via a questionnaire following up previous research with this cohort on 'fear of death'. Although self-selecting, interviewees were not significantly different from those who did not volunteer for interview in any of the statistical analyses of the questionnaire data. There were a number of similarities in their accounts of their care of dying people. Common themes were that the care of dying people was important, rewarding and satisfying; that the GPs saw themselves as part of a team of carers, frequently as team co-ordinators; good working relationships with district nurses but less satisfactory relationships with hospitals and social workers; that patient and family were both recipients of care; and honesty in communication with dying people, albeit tempered. Three issues of contemporary relevance were: tensions over the role of hospice and specialist terminal care services; care of people with chronic terminal illnesses other than cancer; and the role of GPs in the social construction of bereavement.
在现代英国，大多数临终关怀是在人们自己家中进行的，许多临终患者及其护理者更希望在自己家中离世。家庭临终关怀的质量以及在家中离世的可能性在很大程度上取决于全科医生（GP）和社区护士所提供的护理。本文报告了全科医生在照顾临终患者方面的经历以及他们对这项工作的态度。它基于对25名毕业于莱斯特大学医学院1979年入学批次的全科医生进行的非结构化访谈。受访者是通过一份问卷招募的，该问卷是对该批次学生之前关于“死亡恐惧”的研究的跟进。尽管是自我选择，但在对问卷数据的任何统计分析中，受访者与那些未自愿参加访谈的人没有显著差异。他们在讲述照顾临终患者的经历时有许多相似之处。共同的主题包括：照顾临终患者很重要且有意义、令人满足；全科医生将自己视为护理团队的一员，经常担任团队协调员；与地区护士有良好的工作关系，但与医院和社会工作者的关系不太令人满意；患者和家属都是护理的接受者；以及与临终患者沟通时要诚实，尽管要有所缓和。有三个与当代相关的问题：临终关怀和专科临终护理服务角色的紧张关系；癌症以外的慢性临终疾病患者的护理；以及全科医生在丧亲之痛的社会建构中的作用。
