Abandonment at the end of life from patient, caregiver, nurse, and physician perspectives: loss of continuity and lack of closure.
Abandonment at the end of life from patient, caregiver, nurse, and physician perspectives: loss of continuity and lack of closure.
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DOI：
10.1001/archinternmed.2008.583
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发表时间：
2009-03-09
影响因子：
--
通讯作者：
Curtis, J. Randall
中科院分区：
文献类型：
--
作者：
Back, Anthony L.;Young, Jessica P.;McCown, Ellen;Engelberg, Ruth A.;Vig, Elizabeth K.;Reinke, Lynn F.;Wenrich, Marjorie D.;McGrath, Barbara B.;Curtis, J. Randall
调查和轶事表明，在过渡到临终关怀的过程中，患者和家属有时会感到被医生遗弃。据我们所知，先前的研究没有前瞻性地描述遗弃。我们使用基于社区的样本对患者、家庭照顾者、医生和护士进行了纵向、定性的研究。使用有目的的招募策略，我们确定了31名医生，他们确定了55名患有不治之症癌症或晚期慢性阻塞性肺疾病(COPD)的患者，36名家庭照顾者和25名护士。符合条件的患者符合预后标准，即如果死亡发生在一年内，他们的医生“不会感到惊讶”。定性的半结构化访谈在注册时、4-6个月和12个月进行，并由跨学科团队进行录音、转录和编码。当被要求谈论希望和预测信息时，参与者自发地提出了对遗弃的担忧，我们将这个话题纳入了我们的面试指南。确定了两个主题：(1)死前，患者和医生之间失去连续性而产生的遗弃担忧；(2)在死亡时或死后，患者和家人因缺乏关爱而产生的遗弃感。医生报告说没有关闭，但没有讨论这是被遗弃。临终时不放弃的职业价值包括两个不同的要素：(1)提供专业知识和患者-临床医生关系的连续性；(2)促进重要治疗关系的结束。将这一专业价值框定为连续性和封闭性，可以促进干预措施的发展，以改善临终关怀的这一方面。
Surveys and anecdotes suggest that patients and family members sometimes feel abandoned by their physicians at the transition to end-of-life care. To our knowledge, no prior studies describe abandonment prospectively. We conducted a longitudinal, qualitative study of patients, family caregivers, physicians and nurses using a community-based sample. Using a purposive recruitment strategy, we identified 31 physicians, who identified 55 patients with incurable cancer or advanced chronic obstructive pulmonary disease (COPD), 36 family caregivers, and 25 nurses. Eligible patients met the prognostic criterion that their physician ‘would not be surprised’ if death occurred within a year. Qualitative semi-structured interviews were performed at enrollment, 4–6 months and 12 months, and were audiotaped, transcribed and coded by an interdisciplinary team. When asked to talk about hope and prognostic information, participants spontaneously raised concerns about abandonment, and we incorporated this topic into our interview guide. Two themes were identified: (1) before death, abandonment worries related to loss of continuity between patient and physician; (2) at the time of death or after, feelings of abandonment resulted from lack of closure for patients and families. Physicians reported lack of closure but did not discuss this as abandonment. The professional value of nonabandonment at the end of life consists of two different elements: (1) providing continuity, of both expertise and the patient-clinician relationship; and (2) facilitating closure of an important therapeutic relationship. Framing this professional value as continuity and closure could promote the development of interventions to improve this aspect of end-of-life care.
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影响因子：
120.7
作者：
Meier, DE;Back, AL;Morrison, RS
通讯作者：
Morrison, RS
影响因子：
2.8
作者：
Reinke, Lynn F.;Engelberg, Ruth A.;Curtis, J. Randall
通讯作者：
Curtis, J. Randall
影响因子：
120.7
作者：
Teno, JM;Clarridge, BR;Mor, V
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Mor, V
影响因子：
39.2
作者：
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影响因子：
8.8
作者：
Stapleton, Renee D.;Engelberg, Ruth A.;Curtis, J. Randall
通讯作者：
Curtis, J. Randall