Transitions regarding palliative and end-of-life care in severe chronic obstructive pulmonary disease or advanced cancer: Themes identified by patients, families, and clinicians
Transitions regarding palliative and end-of-life care in severe chronic obstructive pulmonary disease or advanced cancer: Themes identified by patients, families, and clinicians
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DOI：
10.1089/jpm.2007.0236
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发表时间：
2008-05-01
影响因子：
2.8
通讯作者：
Curtis, J. Randall
中科院分区：
文献类型：
--
作者：
Reinke, Lynn F.;Engelberg, Ruth A.;Curtis, J. Randall
背景资料：生命末期（EOL）疾病的经典轨迹表明癌症患者与慢性阻塞性肺疾病（COPD）患者的护理需求不同，并且可能导致在生命限制性疾病过程中的不同过渡体验。患者可能会以与临床医生不同的方式经历过渡。没有先前的研究已经检查了这个问题，从病人的，家庭的，和临床医生的perspectives.Objectives：我们试图探讨过渡，定义为经验，病人和家庭成员认为是里程碑，在他们的疾病和治疗的演变，并比较这些看法与病人的医生和护士的角度，提供有关终末期护理沟通的见解。我们使用扎根理论进行了一项定性研究，以检查参与者对晚期COPD或癌症患者关键转变经历的看法。与病人，家属，护士和医生进行了深入的采访，由经验丰富的interviewers.Results：六个主题被确定为参与者的经验与过渡。定义COPD患者和癌症患者之间过渡的主题包括：新的或不同的治疗方法以及没有更多的治疗方法。COPD患者的独特主题是由于功能下降和开始氧疗导致的活动受限。一个独特的主题，临床医生是急性加重的疾病或hospitalization.Conclusions：这项研究确定了差异的意义上的过渡患者与临床医生和COPD患者与癌症患者。这些发现可能为临床医生提供机会，通过从患者和家庭的角度承认和解决姑息治疗的过渡，提供一个更加以患者为中心的方法来沟通临终关怀。
Background: Classic trajectories of illness at end of life (EOL) suggest different care needs for patients with cancer versus chronic obstructive pulmonary disease (COPD) and may lead to different experiences of transitions over the course of a life-limiting illness. Patients may experience transitions in different ways than clinicians. No prior studies have examined this issue from patients', families', and clinicians' perspectives.Objectives: We sought to explore transitions, defined as experiences that patients and family members viewed as milestones in the evolution of their illnesses and therapies, and compare these perceptions with the perspectives of the patient's physician and nurse to provide insights about communication concerning EOL care.Methods: We conducted a qualitative study using grounded theory to examine participants' perspectives on the experiences of key transitions in the context of living with advanced COPD or cancer. In-depth interviews with patients, family members, nurses, and physicians were conducted by experienced interviewers.Results: Six themes were identified regarding participants' experiences with transitions. Themes that defined transitions among both patients with COPD and those with cancer included: new or different treatments and no more treatments available. Themes unique to patients with COPD were activity limitations due to functional decline and initiation of oxygen therapy. One theme unique to clinicians was acute exacerbation of illness or hospitalization.Conclusions: This study identified differences in the meaning of transitions for patients versus clinicians and for patients with COPD versus those with cancer. These findings may offer clinicians the opportunity to provide a more patient-centered approach to communication about end-of-life care by acknowledging and addressing transitions in palliative care from the perspective of the patient and family.