Harris T, Kendrick T
Department of General Practice and Primary Care, St George's Hospital Medical School, London.
Br J Gen Pract. 1998 Sep;48(434):1560-4.
Studies have shown that bereaved individuals suffer increased rates of physical and mental ill health. Bereavement support has recently been advocated as an area of prevention in primary care, with suggestions that general practitioners (GPs) should adopt protocols for the active follow-up of their bereaved patients, which relies on the early notification of deaths by hospitals and hospices. Little is known about the routine care currently provided by GPs and primary health care teams (PHCTs) to support their bereaved patients.
To explore GPs' perceptions of patient death notifications by hospitals and hospices. To describe practice policies relating to patient deaths and the provision of bereavement support.
Postal questionnaires were sent to senior partners of a random sample of 500 general practices in South Thames Health Region.
Three hundred and fifty-three practitioners responded (71%). Hospitals were perceived to be significantly slower than hospices in notifying deaths (P < 0.0001). One hundred and ninety-six practices (56%) kept death registers, 230 (65%) discussed deaths together, and 142 (40%) identified bereaved relatives. One hundred and thirty-seven practices (39%) routinely offered bereaved relatives contact with a PHCT member; while 133 (38%) supported only those who asked for help. Routine support was significantly more likely to be provided by practices that kept a death register, discussed deaths together, identified bereaved relatives, and had a special interest in palliative care.
GPs perceive hospitals to be slower than hospices at notifying deaths, particularly in the first 24 hours. They are divided over whether bereavement support should be proactive or reactive. Keeping a practice death register, discussing deaths together, and identifying newly bereaved relatives are activities related to providing routine bereavement care.
研究表明，经历丧亲之痛的人身心健康问题增多。丧亲支持最近被倡导为初级保健中的一个预防领域，有人建议全科医生（GP）应为其丧亲患者采取积极随访方案，这依赖于医院和临终关怀机构对死亡情况的早期通知。目前对于全科医生和初级卫生保健团队（PHCT）为支持其丧亲患者而提供的常规护理知之甚少。
探讨全科医生对医院和临终关怀机构患者死亡通知的看法。描述与患者死亡及提供丧亲支持相关的实践政策。
向南泰晤士健康区域随机抽取的500家全科诊所的高级合伙人发送邮政问卷。
353名从业者回复（71%）。医院在通知死亡方面被认为比临终关怀机构慢得多（P < 0.0001）。196家诊所（56%）保存死亡登记册，230家（65%）共同讨论死亡情况，142家（40%）确定丧亲亲属。137家诊所（39%）常规为丧亲亲属提供与初级卫生保健团队成员联系的机会；而133家（38%）仅支持那些寻求帮助的人。保存死亡登记册、共同讨论死亡情况、确定丧亲亲属且对姑息治疗有特殊兴趣的诊所更有可能提供常规支持。
全科医生认为医院在通知死亡方面比临终关怀机构慢，尤其是在最初24小时内。他们在丧亲支持应是主动还是被动方面存在分歧。保存诊所死亡登记册、共同讨论死亡情况以及确定新丧亲亲属是与提供常规丧亲护理相关的活动。
