Advance care planning for cancer patients in primary care: a feasibility study
Advance care planning for cancer patients in primary care: a feasibility study
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DOI：
10.3399/bjgp10x544032
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发表时间：
2010-12-01
影响因子：
5.9
通讯作者：
Murray, Scott A.
中科院分区：
文献类型：
--
作者：
Boyd, Kirsty;Mason, Bruce;Murray, Scott A.
在许多发达国家，预先护理规划正在作为生命终了政策的核心组成部分得到推广，目的评估在英国初级保健中实施预先护理计划的可行性研究设计混合方法评估试点教育干预设置四个一般做法在南方-方法在一个基于实践的研讨会之前和之后采访了20名全科医生和8名社区护士;随后对来自英国各地的其他9名对姑息治疗特别感兴趣的全科医生进行了电话采访。患者的生命护理计划通常开始于对短期预后的明确证据的紧急反应，并且旨在实现“好的死亡”。研究结果表明，早期计划有多种障碍：预后不确定性;与二级护理的合作有限;希望保持希望;以及对任何类型的“勾选框”方法的抵制。讲习班之后，参加者的知识和技能得到了提高，但几乎没有证据表明他们进行了更积极主动的规划。来自英国其他地区的全科医生描述了混乱的术语，并关注实施灵活，政策驱动的care.ConclusionA明确的分歧之间的困难，英国的政策指令和交付的临终关怀在社会上，针对初级保健专业人员的教育干预措施是不可能解决的。提前护理规划有可能促进关于临终护理的自主权和共同决策，但这需要态度的重大转变。
BackgroundAdvance care planning is being promoted as a central component of end-of-life policies in many developed countries, but there is concern that professionals find its implementation challenging.AimTo assess the feasibility of implementing advance care planning in UK primary care.Design of studyMixed methods evaluation of a pilot educational intervention.SettingFour general practices in south-east Scotland.MethodInterviews with 20 GPs and eight community nurses before and after a practice-based workshop; this was followed by telephone interviews with nine other GPs with a special interest in palliative care from across the UK.ResultsEnd-of-life care planning for patients typically starts as an urgent response to clear evidence of a short prognosis, and aims to achieve a "good death". Findings suggest that there were multiple barriers to earlier planning: prognostic uncertainty; limited collaboration with secondary care; a desire to maintain hope; and resistance to any kind of "tick-box" approach. Following the workshop, participants' knowledge and skills were enhanced but there was little evidence of more proactive planning. GPs from other parts of the UK described confusion over terminology and were concerned about the difficulties of implementing inflexible, policy-driven care.ConclusionA clear divide was found between UK policy directives and delivery of end-of-life care in the community that educational interventions targeting primary care professionals are unlikely to address. Advance care planning has the potential to promote autonomy and shared decision making about end-of-life care, but this will require a significant shift in attitudes.