Transitions to palliative care in acute hospitals in England: qualitative study
Transitions to palliative care in acute hospitals in England: qualitative study
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DOI：
10.1136/bmj.d1773
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发表时间：
2011-03-29
影响因子：
105.7
通讯作者：
Gardiner, Clare
中科院分区：
文献类型：
--
作者：
Gott, Merryn;Ingleton, Christine;Gardiner, Clare
目的探讨如何过渡到姑息治疗方法被认为是在急性医院设置在英格兰管理。设计定性研究。设置二级或初级保健设置在两个对比地区的英格兰。参与者58名卫生专业人员参与提供姑息治疗的二级或初级保健。结果参与者确定，结构化过渡到姑息治疗方法的类型提倡在英国在急症医院环境中，政策指导很少明显。特别是，他们报告说，预后是不定期讨论住院病人。临床团队就过渡到姑息治疗达成共识被视为实现过渡的基础;然而，这被认为在实践中没有充分实现。二级保健专业人员报告说，关于采用姑息治疗方法进行患者管理的讨论并不经常与患者进行;初级保健专业人员证实，患者出院时往往抱着治愈的“虚假希望”，因为没有传达这一信息。确保平稳过渡到姑息治疗的主要障碍包括在紧急医院情况下难以“退后”，专业等级制度限制了初级医疗和护理人员参与护理决策的能力，结论：在急性医院实施结构性过渡到姑息治疗的政策的重大障碍是由初级和中级卫生专业人员确定的。二级保健.这些需要得到解决，如果目前的英国急性医院姑息治疗的管理政策是要建立。
Objective To explore how transitions to a palliative care approach are perceived to be managed in acute hospital settings in England.Design Qualitative study.Setting Secondary or primary care settings in two contrasting areas of England.Participants 58 health professionals involved in the provision of palliative care in secondary or primary care.Results Participants identified that a structured transition to a palliative care approach of the type advocated in UK policy guidance is seldom evident in acute hospital settings. In particular they reported that prognosis is not routinely discussed with inpatients. Achieving consensus among the clinical team about transition to palliative care was seen as fundamental to the transition being effected; however, this was thought to be insufficiently achieved in practice. Secondary care professionals reported that discussions about adopting a palliative care approach to patient management were not often held with patients; primary care professionals confirmed that patients were often discharged from hospital with "false hope" of cure because this information had not been conveyed. Key barriers to ensuring a smooth transition to palliative care included the difficulty of "standing back" in an acute hospital situation, professional hierarchies that limited the ability of junior medical and nursing staff to input into decisions on care, and poor communication.Conclusion Significant barriers to implementing a policy of structured transitions to palliative care in acute hospitals were identified by health professionals in both primary and secondary care. These need to be addressed if current UK policy on management of palliative care in acute hospitals is to be established.