Brown J B, Sangster M, Swift J
Centre for Studies in Family Medicine, University of Western Ontario, London.
Can Fam Physician. 1998 May;44:1028-34.
To examine factors that influence family physicians' decisions to practise palliative care.
Qualitative method of in-depth interviews.
Southwestern Ontario.
Family physicians who practise palliative care on a full-time basis, who practise on a part-time basis, or who have retired from active involvement in palliative care.
Eleven in-depth interviews were conducted to explore factors that influence family physicians' decisions to practise palliative care and factors that sustain their interest in palliative care. All interviews were audiotaped and transcribed verbatim. The analysis strategy used a phenomenological approach and occurred concurrently rather than sequentially. All interview transcriptions were read independently by the researchers, who then compared and combined their analyses. Final analysis involved examining all interviews collectively, thus permitting relationships between and among central themes to emerge.
The overriding theme was a common philosophy of palliative care focusing on acceptance of death, whole person care, compassion, communication, and teamwork. Participants' philosophies were shaped by their education and by professional and personal experiences. In addition, participants articulated personal and systemic factors currently affecting their practice of palliative care.
Participants observed that primary care physicians should be responsible for their patients' palliative care within the context of interdisciplinary teams. For medical students to be knowledgeable and sensitive to the needs of dying patients, palliative care should be given higher priority in the curriculum. Finally, participants argued compellingly for transferring the philosophy of palliative care to the overall practice of medicine.
探讨影响家庭医生开展姑息治疗决策的因素。
深入访谈的定性研究方法。
安大略省西南部。
全职开展姑息治疗、兼职开展姑息治疗或已从积极参与姑息治疗工作中退休的家庭医生。
进行了11次深入访谈，以探究影响家庭医生开展姑息治疗决策的因素以及维持他们对姑息治疗兴趣的因素。所有访谈均进行了录音并逐字转录。分析策略采用现象学方法，同步而非顺序进行。研究人员独立阅读所有访谈转录本，然后比较并整合他们的分析。最终分析涉及对所有访谈进行综合审视，从而使核心主题之间的关系得以显现。
首要主题是一种共同的姑息治疗理念，重点关注对死亡的接纳、全人护理、同情、沟通和团队合作。参与者的理念受其教育以及专业和个人经历的影响。此外，参与者阐述了当前影响其姑息治疗实践的个人和系统因素。
参与者指出，在跨学科团队背景下，初级保健医生应对其患者的姑息治疗负责。为使医学生了解并敏感对待临终患者的需求，应在课程中给予姑息治疗更高的优先级。最后，参与者强烈主张将姑息治疗理念应用于医学的整体实践中。
