Barriers of Healthcare Providers Against End-of-life Discussions with Pediatric Cancer Patients
Barriers of Healthcare Providers Against End-of-life Discussions with Pediatric Cancer Patients
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DOI：
10.1093/jjco/hyu077
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发表时间：
2014-08-01
影响因子：
2.4
通讯作者：
Kato, Masashi
中科院分区：
文献类型：
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作者：
Yoshida, Saran;Shimizu, Ken;Kato, Masashi
目的：对于肿瘤科医生来说，与患者进行临终讨论可能是最困难和压力最大的任务之一。然而，人们对医疗保健提供者在这种情况下与患者进行的讨论以及他们面临的困难知之甚少。本研究的主要终点是描述儿科环境中临终讨论的内容以及儿科医疗保健提供者认为儿科患者临终讨论的障碍。方法：参与者为 10 名医疗保健提供者。进行半结构化访谈，并采用 KJ 方法分析数据。结果：我们发现了 23 个阻碍与儿科癌症患者进行临终讨论的障碍。这些障碍分为以下几类：医疗保健提供者因素、患者因素、家长因素以及制度或文化因素。除了之前研究中发现的障碍之外，还发现了一些独特的障碍，例如“讨论后缺乏面对患者的信心”、“治疗决策的责任不确定”和“没有令人信服的理由进行讨论”。医疗保健提供者积极讨论治疗目的以及患者的愿望和担忧；然而，他们不愿意处理患者自己即将到来的死亡和他们的估计预后。结论：儿科患者的临终讨论与成人患者的讨论不同。需要进一步的研究来分析与临终讨论相关的儿科案例，并仔细讨论其充分性、利弊。
Objective: End-of-life discussions with patients can be one of the most difficult and stressful tasks for the oncologist. However, little is known about the discussions that healthcare providers have with patients in such situations and the difficulties they face. The primary end points of this study were to describe the contents of end-of-life discussion in the pediatric setting and the barriers to end-of-life discussion for pediatric patients, as perceived by pediatric healthcare providers.Methods: Participants were 10 healthcare providers. Semi-structured interviews were conducted, and the KJ method was performed to analyze the data.Results: We found 23 barriers against end-of-life discussion with pediatric cancer patients. These barriers were classified as follows: healthcare provider factors, patient factors, parent factors and institutional or cultural factors. In addition to barriers found in previous studies, some unique barriers were uncovered such as, 'Lack of confidence to face the patient after the discussion', 'Uncertain responsibility for treatment decision-making' and 'No compelling reason to discuss'. Healthcare providers actively discussed the purpose of treatment and the patients' wishes and concerns; however, they were reluctant to deal with the patients' own impending death and their estimated prognosis.Conclusions: End-of-life discussion with pediatric patients differs from that with adult patients. Further studies are required to analyze pediatric cases associated with end-of-life discussion and carefully discuss its adequacy, pros and cons.