Breaking silence: a survey of barriers to goals of care discussions from the perspective of oncology practitioners
Breaking silence: a survey of barriers to goals of care discussions from the perspective of oncology practitioners
复制标题
DOI：
10.1186/s12885-019-5333-x
复制
发表时间：
2019-02-08
期刊：
影响因子：
3.8
通讯作者：
You, John J.
中科院分区：
文献类型：
--
作者：
Piggott, Katrina Lynn;Patel, Ameen;You, John J.
背景癌症是发达国家的首要死因，但医疗保健从业者很少与住院癌症患者讨论护理目标 (GoC)。我们试图从肿瘤科医生、肿瘤住院医师和肿瘤护士的角度找出 GoC 讨论的障碍。方法这是对肿瘤科医生、肿瘤住院医师和住院肿瘤护士的单中心调查。 GoC 讨论的障碍采用 7 点李克特量表进行评估（1 = 极其不重要；7 = 极其重要）。 结果 2013 年 7 月至 2014 年 5 月，185 名符合条件的肿瘤科临床医生、30 名肿瘤科医生、10 名肿瘤科住院医师和 28 名肿瘤科护士返回了调查（答复率为 37%）。 GoC 讨论的最重要障碍是患者和家庭因素。其中包括家庭成员难以接受不良预后（平均分 5.9, 95% CI [5.7, 6.2]）、家庭对护理目标缺乏共识（平均分 5.8, 95% CI [5.5, 6.1]）、难以理解维持生命治疗的局限性（平均分 5.8, 95% CI [5.6, 6.1]）、患者缺乏制定治疗目标的能力。护理决策（平均分 5.7，95% CI [5.5，6.0]）和语言障碍（平均分 5.7，95% CI [5.4，5.9]）。参与者认为系统因素和医疗保健提供者因素不太重要。结论肿瘤学从业者认为患者和家庭因素是 GoC 讨论的最大限制障碍。我们的研究结果强调，肿瘤临床医生需要具备强大的沟通技巧，以帮助患者和家属顺利进行 GoC 讨论。
BackgroundCancer is the leading cause of death in the developed world, and yet healthcare practitioners infrequently discuss goals of care (GoC) with hospitalized cancer patients. We sought to identify barriers to GoC discussions from the perspectives of staff oncologists, oncology residents, and oncology nurses.MethodsThis was a single center survey of staff oncologists, oncology residents, and inpatient oncology nurses. Barriers to GoC discussions were assessed on a 7-point Likert scale (1=extremely unimportant; 7=extremely important).ResultsBetween July 2013 and May 2014, of 185 eligible oncology clinicians, 30 staff oncologists, 10 oncology residents, and 28 oncology nurses returned surveys (response rate of 37%). The most important barriers to GoC discussions were patient and family factors. They included family members' difficulty accepting poor prognoses (mean score 5.9, 95% CI [5.7, 6.2]), lack of family agreement in the goals of care (mean score 5.8, 95% CI [5.5, 6.1]), difficulty understanding the limitations of life-sustaining treatments (mean score 5.8, 95% CI [5.6, 6.1]), lack of patients' capacity to make goals of care decisions (mean score 5.7, 95% CI [5.5, 6.0]), and language barriers (mean score 5.7, 95% CI [5.4, 5.9]). Participants viewed system factors and healthcare provider factors as less important barriers.ConclusionsOncology practitioners perceive patient and family factors as the most limiting barriers to GoC discussions. Our findings underscore the need for oncology clinicians to be equipped with strong communication skills to help patients and families navigate GoC discussions.