Australian General Practitioners' and Oncology Specialists' Perceptions of Barriers and Facilitators of Access to Specialist Palliative Care Services
Australian General Practitioners' and Oncology Specialists' Perceptions of Barriers and Facilitators of Access to Specialist Palliative Care Services
复制标题
澳大利亚全科医生和肿瘤专科医生对获得姑息关怀专科服务的障碍和促进因素的看法
DOI：
10.1089/jpm.2010.0259
复制
发表时间：
2011-04-01
影响因子：
2.8
通讯作者：
Currow, David C.
中科院分区：
文献类型：
--
作者：
Johnson, Claire;Paul, Chris;Currow, David C.
目的：澳大利亚的医生在促进晚期癌症患者获得专业姑息治疗（SPC）服务方面发挥着重要作用。本研究旨在描述医生对转诊SPC患者的障碍的看法，并确定转诊的触发因素和促进因素。方法：对40位参与晚期癌症患者护理的医生进行了半结构化电话访谈。结果：确定了六个主题：疾病和治疗；社会心理;沟通和人际关系问题；保健服务问题；时机;还有，卫生专业人员的技能。所有医生都认为身体症状的存在和复杂性、疾病的阶段和治疗方向在决定是否转诊SPC时都是重要的。不那么重要的是癌症患者及其家庭的社会心理健康和文化特征。据报告，影响转诊和获取的因素包括卫生专业人员公开和诚实地沟通疾病进展的能力、SPC资源的可用性和位置以及医生的专业知识。关于适当的访问时间，人们表达了不同的意见。主要观点认为SPC是用于身体症状的管理，可能导致那些没有身体症状的复杂问题的不转诊。结论：鉴于心理和身体健康与健康相关生活质量之间的复杂关系，确定影响患者健康的所有因素非常重要。常规使用未满足和复杂需求的客观测量可能有助于确定最有可能从SPC获益的人群并优化获取，而不考虑时间、疾病阶段和治疗方向。
Purpose: Doctors in Australia play an important role in facilitating access to specialist palliative care (SPC) services for people with advanced cancer. This study aimed to describe doctors' perceptions of barriers to referring patients for SPC, and to identify triggers and facilitators for referral.Method: Forty semistructured telephone interviews were conducted with doctors involved in the care of people with advanced cancer from a variety of settings.Results: Six themes were identified: disease and treatment; psychosocial; communication and interpersonal issues; health services issues; timing; and, health professionals' skills. All doctors considered the presence and complexity of physical symptoms, stage of the disease and treatment orientation as important in decisions to refer for SPC. Less important were the psychosocial well-being and cultural characteristics of the person with cancer and their family. Factors reportedly affecting referral and access included health professionals' ability to communicate openly and honestly about disease progression, availability and location of SPC resources and doctors' expertise. Divergent views were expressed about appropriate timing for access. The predominant view that SPC is for management of physical symptoms may result in nonreferral of those who have complex problems without physical symptoms.Conclusions: Given the complex relationship between psychological and physical well-being and health-related quality of life, it is important that all factors contributing to patient well-being are identified. Routine use of objective measures of unmet and complex needs may help identify people who are likely to most benefit from SPC and optimize access, regardless of timing, stage of disease, and treatment orientation.