PDF(Pubmed)
Abstract：
UNASSIGNED: Demographic changes, the evolvement of modern medicine and new treatments for severe diseases, increase the need for palliative care services. Palliative care includes all patients with life-limiting conditions, irrespective of diagnosis. In Norway, palliative care rests on a decentralised model where patient care can be delivered close to the patient\'s home, and the Norwegian guideline for palliative care describes a model of care resting on extensive collaboration. Previous research suggests that this guideline is not well implemented among general practitioners (GPs). In this study, we aim to investigate barriers to GPs\' participation in palliative care and implementation of the guideline.
UNASSIGNED: We interviewed 25 GPs in four focus groups guided by a semi-structured interview guide. The interviews were recorded and transcribed verbatim. Data were analysed qualitatively with reflexive thematic analysis.
UNASSIGNED: We identified four main themes as barriers to GPs\' participation in palliative care and to implementation of the guideline: (1) different established local cultures and practices of palliative care, (2) discontinuity of the GP-patient relationship, (3) unclear clinical handover and information gaps and (4) a mismatch between the guideline and everyday general practice.
UNASSIGNED: Significant structural and individual barriers to GPs\' participation in palliative care exist, which hamper the implementation of the guideline. GPs should be involved as stakeholders when guidelines involving them are created. Introduction of new professionals in primary care needs to be actively managed to avoid inappropriate collaborative practices. Continuity of the GP-patient relationship must be maintained throughout severe illness and at end-of-life.
According to the Norwegian guideline for palliative care, the GP should have a central position in providing primary palliative care.Recent research and public reports suggest that not all GPs have such a central role or adhere to the guidelines.This study highlights individual and structural barriers that could be addressed to increase GPs’ participation in palliative care and aid the implementation of the guidelines for palliative care.
UNASSIGNED: We interviewed 25 GPs in four focus groups guided by a semi-structured interview guide. The interviews were recorded and transcribed verbatim. Data were analysed qualitatively with reflexive thematic analysis.
UNASSIGNED: We identified four main themes as barriers to GPs\' participation in palliative care and to implementation of the guideline: (1) different established local cultures and practices of palliative care, (2) discontinuity of the GP-patient relationship, (3) unclear clinical handover and information gaps and (4) a mismatch between the guideline and everyday general practice.
UNASSIGNED: Significant structural and individual barriers to GPs\' participation in palliative care exist, which hamper the implementation of the guideline. GPs should be involved as stakeholders when guidelines involving them are created. Introduction of new professionals in primary care needs to be actively managed to avoid inappropriate collaborative practices. Continuity of the GP-patient relationship must be maintained throughout severe illness and at end-of-life.
According to the Norwegian guideline for palliative care, the GP should have a central position in providing primary palliative care.Recent research and public reports suggest that not all GPs have such a central role or adhere to the guidelines.This study highlights individual and structural barriers that could be addressed to increase GPs’ participation in palliative care and aid the implementation of the guidelines for palliative care.
摘要：
■人口变化，现代医学的发展和严重疾病的新疗法，增加对姑息治疗服务的需求。姑息治疗包括所有患有生命受限疾病的患者，不管诊断。在挪威,姑息治疗建立在分散的模式上，病人护理可以在病人家附近提供，挪威姑息治疗指南描述了一种基于广泛合作的护理模式。先前的研究表明，该指南在全科医生（GP）中没有得到很好的实施。在这项研究中,我们旨在调查全科医生参与姑息治疗和实施指南的障碍.
■我们在半结构化访谈指南的指导下，在四个焦点小组中采访了25位GP。访谈被逐字记录和转录。数据采用反身性专题分析进行定性分析。
■我们确定了四个主要主题作为全科医生参与姑息治疗和实施指南的障碍：（1）不同的当地文化和姑息治疗实践，（2）GP-患者关系的不连续性，（3）不清楚的临床移交和信息差距，以及（4）指南与日常一般实践之间的不匹配。
■全科医生参与姑息治疗存在重大的结构和个人障碍，这阻碍了该准则的实施。当制定涉及GP的准则时，GP应作为利益相关者参与。需要积极管理初级保健新专业人员的引入，以避免不适当的合作做法。在整个严重疾病和生命结束时，必须保持全科医生与患者关系的连续性。
根据挪威姑息治疗指南，全科医生在提供初级姑息治疗方面应处于中心地位.最近的研究和公开报告表明，并非所有全科医生都具有这样的核心作用或遵守准则。这项研究强调了可以解决的个人和结构性障碍，以增加全科医生对姑息治疗的参与并帮助实施姑息治疗指南。
■我们在半结构化访谈指南的指导下，在四个焦点小组中采访了25位GP。访谈被逐字记录和转录。数据采用反身性专题分析进行定性分析。
■我们确定了四个主要主题作为全科医生参与姑息治疗和实施指南的障碍：（1）不同的当地文化和姑息治疗实践，（2）GP-患者关系的不连续性，（3）不清楚的临床移交和信息差距，以及（4）指南与日常一般实践之间的不匹配。
■全科医生参与姑息治疗存在重大的结构和个人障碍，这阻碍了该准则的实施。当制定涉及GP的准则时，GP应作为利益相关者参与。需要积极管理初级保健新专业人员的引入，以避免不适当的合作做法。在整个严重疾病和生命结束时，必须保持全科医生与患者关系的连续性。
根据挪威姑息治疗指南，全科医生在提供初级姑息治疗方面应处于中心地位.最近的研究和公开报告表明，并非所有全科医生都具有这样的核心作用或遵守准则。这项研究强调了可以解决的个人和结构性障碍，以增加全科医生对姑息治疗的参与并帮助实施姑息治疗指南。
