Does Palliative Care Have a Future in the Emergency Department? Discussions With Attending Emergency Physicians
Does Palliative Care Have a Future in the Emergency Department? Discussions With Attending Emergency Physicians
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DOI：
10.1016/j.jpainsymman.2011.03.022
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发表时间：
2012-01-01
影响因子：
4.7
通讯作者：
Morrison, R. Sean
中科院分区：
文献类型：
--
作者：
Grudzen, Corita R.;Richardson, Lynne D.;Morrison, R. Sean
语境。姑息治疗的重点是减轻疼痛和痛苦，并为患者实现尽可能最好的生活质量。虽然传统上是在住院环境中提供服务，但急诊科 (ED) 已成为姑息治疗咨询团队的新焦点。目标。探讨急诊护理提供者对于在 ED.Methods 中提供姑息治疗服务的态度和信念。来自学术医疗中心、公立医院中心和社区医院的主治急诊医生进行了三个半结构化焦点小组。讨论被数字化记录和转录，以使用扎根理论进行主题分析。迭代开发了编码方案，以随后识别访谈中出现的主题和子主题。结果。 20 名急诊医生参与其中（平均年龄 41 岁，范围 31-61 岁，中位执业时间 9 年，40% 为女性）。提供者承认急诊室提供姑息治疗有许多好处，包括提供专业技能、讨论护理目标的时间以及对重病或受伤患者进行干预的机会。提供者认为，对法医学问题的担忧削弱了他们放弃风险大于收益的治疗的能力。此外，急诊医学的文化——稳定急性医疗紧急情况——有时与姑息治疗的文化不一致，姑息治疗在生活质量与侵入性治疗的负担之间取得平衡。一些医疗服务提供者还认为，实现护理目标是主治医生的责任，而不是他们自己的责任。最后，一些提供者担心姑息治疗咨询只能在工作日的白天进行。建议基于预定标准的自动会诊作为避免与患者和家人发生冲突的一种方式。结论。急救人员发现姑息治疗咨询有很多好处。解决后勤问题并制定明确的咨询指示可能有助于增加此类服务的使用。 J 疼痛症状管理 2012；43：1-9。 (C) 2012 年美国癌症疼痛缓解委员会。由爱思唯尔公司出版。保留所有权利。
Context. Palliative care focuses on the relief of pain and suffering and achieving the best possible quality of life for patients. Although traditionally delivered in the inpatient setting, emergency departments (EDs) are a new focus for palliative care consultation teams.Objectives. To explore attitudes and beliefs among emergency care providers regarding the provision of palliative care services in the ED.Methods. Three semistructured focus groups were conducted with attending emergency physicians from an academic medical center, a public hospital center, and a community hospital. The discussions were digitally recorded and transcribed to conduct a thematic analysis using grounded theory. A coding scheme was iteratively developed to subsequently identify themes and subthemes that emerged from the interviews.Results. Twenty emergency physicians participated (mean age 41 years, range 31-61 years, median practice time nine years, 40% female). Providers acknowledged many benefits of palliative care presence in the ED, including provision of a specialized skill set, time to discuss goals of care, and an opportunity to intervene for seriously ill or injured patients. Providers believed that concerns about medicolegal issues impaired their ability to forgo treatments where risks outweigh benefits. Additionally, the culture of emergency medicine-to provide stabilization of acute medical emergencies-was sometimes at odds with the culture of palliative care, which balances quality of life with the burdens of invasive treatments. Some providers also felt it was the primary physician's responsibility, and not their own, to address goals of care. Finally, some providers expressed concern that palliative care consultation was only available on weekdays during daytime hours. Automatic consultation based on predetermined criteria was suggested as a way to avoid conflicts with patients and family.Conclusion. Emergency providers identified many benefits to palliative care consultation. Solving logistical problems and developing clear indications for consultation might help increase the use of such services. J Pain Symptom Manage 2012;43: 1-9. (C) 2012 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.