General practice physicians' and nurses' self-reported multidisciplinary end-of-life care: a systematic review.
General practice physicians' and nurses' self-reported multidisciplinary end-of-life care: a systematic review.
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DOI：
10.1136/bmjspcare-2019-001852
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发表时间：
2019-08-29
影响因子：
2.7
通讯作者：
Mitchell, Geoffrey
中科院分区：
文献类型：
--
作者：
Senior, Hugh;Grant, Matthew;Mitchell, Geoffrey
背景技术背景：随着人口老龄化，全科医生（GP）和全科护士（GPNs）面临着越来越多的需求，以提供临终关怀（EoLC）。为了提高初级姑息治疗（PC），他们提供的护理需要被理解，以告知最佳实践模式的护理。目的：提供一个全面的描述自我报告的作用和性能的全科医生和GPNs在（1）具体的医疗/护理角色，（2）沟通，（3）护理协调，（4）访问和非小时护理，（5）多学科护理。方法：系统性文献综述。数据来源于Medline、Psychinfo、Embase、Joanna Briggs Institute和科克伦数据库。结果：从6209篇期刊文章中，有29篇综述了GP和GPNs在EoLC或PC实践中的作用。全科医生报告在症状管理，治疗退出，非恶性疾病管理和终端镇静的核心作用。提供的信息包括突发性坏消息、预后和死亡地点。心理社会问题经常得到解决。沟通的质量取决于GP患者的关系和GP技能。挑战是不切实际的病人和家庭的期望，家庭冲突和缺乏提前护理规划。全科医生经常将临终讨论推迟到死亡前3个月。家访是常见的，但城市，女性和兼职全科医生较少。全科医生与二级保健协调护理，但在某些情况下，平行护理发生。对全科医生的信任和可用性对于共同护理至关重要。有最低限度的参考GPNs' roles.CONCLUSIONS：全科医生在姑息治疗中发挥着关键作用。需要在全球方案网络的作用、病例发现和促进共同护理、家访和非工作时间服务的模式方面开展更多工作。
BACKGROUND: General practitioners (GPs) and general practice nurses (GPNs) face increasing demands to provide end-of-life care (EoLC) as the population ages. To enhance primary palliative care (PC), the care they provide needs to be understood to inform best practice models of care.OBJECTIVE: To provide a comprehensive description of the self-reported role and performance of GPs and GPNs in (1) specific medical/nursing roles, (2) communication, (3) care co-ordination, (4) access and out-of-hours care, and (5) multidisciplinary care.METHOD: Systematic literature review. Data included papers (2000 to 2017) sought from Medline, Psychinfo, Embase, Joanna Briggs Institute and Cochrane databases.RESULTS: From 6209 journal articles, 29 reviewed papers reported the GPs' and GPNs' role in EoLC or PC practice. GPs report a central role in symptom management, treatment withdrawal, non-malignant disease management and terminal sedation. Information provision included breaking bad news, prognosis and place of death. Psychosocial concerns were often addressed. Quality of communication depended on GP-patient relationships and GP skills. Challenges were unrealistic patient and family expectations, family conflict and lack of advance care planning. GPs often delayed end-of-life discussions until 3months before death. Home visits were common, but less so for urban, female and part-time GPs. GPs co-ordinated care with secondary care, but in some cases parallel care occurred. Trust in, and availability of, the GP was critical for shared care. There was minimal reference to GPNs' roles.CONCLUSIONS: GPs play a critical role in palliative care. More work is required on the role of GPNs, case finding and models to promote shared care, home visits and out-of-hours services.