神经科医生对姑息治疗的态度和看法:定性研究。

IF 2.3 Q3 CLINICAL NEUROLOGY
Neurology. Clinical practice Pub Date : 2024-10-01 Epub Date: 2024-08-15 DOI:10.1212/CPJ.0000000000200322
Miranda M Wan, Nora D Cristall, Lara J Cooke
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引用次数: 0

摘要

背景和目的:尽管在治疗神经系统疾病方面取得了重大进展,但许多疾病仍需要复杂的护理计划和晚期护理计划。神经科医生处于一个独特的位置,因为他们在提供以患者为中心的护理、了解神经系统疾病和疾病轨迹以及疾病如何影响患者的自我意识和价值观方面发挥着不可或缺的作用。目前,人们对神经科医生在为患者制定护理计划和姑息关怀方面的看法和面临的挑战知之甚少:来自加拿大一家学术机构的神经科医生在 2022 年 11 月至 2023 年 4 月期间参加了一次 30 分钟的半结构式访谈。访谈一直进行到达到饱和并得到确认为止。访谈通过安全平台在线进行,也可当面进行,并有录音。采用建构主义基础理论的不断比较法对数据进行分析。访谈后进行了成员核对:十位神经病学专家参与了此次访谈,他们拥有丰富的神经病学经验和亚专科知识。我们建立了一套详细的理论来理解神经科医生对姑息关怀的态度和看法。当神经科医生延迟或未能启动护理计划讨论或姑息关怀时,这是患者、医生和资源可及性等因素之间复杂相互作用的结果。某些环境因素,如首次就诊或复诊、住院病人与门诊病人的设置、诊所文化以及诊所实践的类型等,都可能影响这些谈话。因此,医生可能无法利用现有资源,也可能会让其他医疗服务提供者参与或转诊至神经病学亚专科诊所。然而,这种延误仍会对患者和医疗服务提供者造成伤害。通过为受训者和员工提供继续教育机会、与姑息关怀专家合作以及卫生系统的支持(如提高公众意识以消除对姑息关怀和资源可用性的误解),存在着改善姑息关怀的机会:我们的研究结果表明,神经科医生未能或延迟启动护理规划和姑息关怀是当地文化、经验、环境、实践类型和患者因素之间复杂相互作用的结果。改善姑息关怀的机会包括增加教育机会、建立综合协作实践和专门的医疗系统支持。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Neurologists' Attitudes and Perceptions on Palliative Care: A Qualitative Study.

Background and objectives: Despite significant advances in the treatment of neurologic disorders, many conditions require complex care planning and advanced care planning. Neurologists are in a unique position because they are integral in providing patient centered care, understanding neurologic disease and illness trajectory, and how disease can affect patients' sense of self and values. Currently, little is known about neurologists' perceptions and challenges in care planning and palliative care for their patients.

Methods: Neurologists from one Canadian academic institution participated in a 30-minute semistructured interview from November 2022 to April 2023. Interviews were conducted until saturation was reached and confirmed. Interviews occurred online through a secure platform or in-person and were recorded. Data were analyzed using a constant comparative method using constructivist grounded theory. Member checking was conducted post interview.

Results: Ten neurologists participated across a broad spectrum of neurology experience and subspecialties. We developed a detailed theory of understanding neurologists' attitudes and perceptions of palliative care. When neurologists delay or fail to initiate care planning discussions or palliative care, it results from a complex interplay between patient, physician, and resource accessibility factors. Certain contextual factors, such as a first visit or follow-up, inpatient vs outpatient setting, clinic culture, and the type of clinic practice, are factors that can influence these conversations. As a result, physicians may fail to use available resources, or they may involve other care providers or refer to subspecialty neurologic clinics. However, this delay can still lead to patient and provider harm. Opportunities to improve care exist with continuing education opportunities for trainees and staff, collaboration with palliative care specialists, and health systems support, such as increasing public awareness to address misconceptions about palliative care and resource availability.

Discussion: Our findings identify that failure or delay to initiate care planning and palliative care by neurologists results from a complex interplay between local culture, experience, context, practice type, and patient factors. Opportunities to improve care include increasing educational opportunities, building integrated and collaborative practices, and dedicated health systems support.

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来源期刊
Neurology. Clinical practice
Neurology. Clinical practice CLINICAL NEUROLOGY-
CiteScore
4.00
自引率
0.00%
发文量
77
期刊介绍: Neurology® Genetics is an online open access journal publishing peer-reviewed reports in the field of neurogenetics. The journal publishes original articles in all areas of neurogenetics including rare and common genetic variations, genotype-phenotype correlations, outlier phenotypes as a result of mutations in known disease genes, and genetic variations with a putative link to diseases. Articles include studies reporting on genetic disease risk, pharmacogenomics, and results of gene-based clinical trials (viral, ASO, etc.). Genetically engineered model systems are not a primary focus of Neurology® Genetics, but studies using model systems for treatment trials, including well-powered studies reporting negative results, are welcome.
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