背景:取消处方已被定义为减少或停止可能不再有益或造成伤害的药物的计划过程,目的是减轻药物负担,同时提高患者的生活质量。目前,对于支持接受姑息治疗的患者开处方的决策的具体挑战知之甚少.通过探索医疗保健专业人员的观点,这项定性研究旨在解决这一差距,并探索挑战,以及潜在的解决方案,在姑息治疗的背景下做出关于取消处方的决定。
方法:与医疗保健专业人员面对面或通过视频通话进行半结构化访谈,2022年8月至2023年1月。关于姑息治疗中开药方法的观点;何时以及如何开药;以及护理人员和家庭成员在此过程中的作用进行了讨论。访谈是录音和逐字转录的。反身性主题分析使主题的发展成为可能。QSRNVivo(版本12)促进了数据管理。伦理批准是从NHS健康研究机构获得的(参考文献305394)。
结果:20名医疗保健专业人员接受了采访,包括:医疗顾问,护士,专业药剂师,和全科医生(GP)。与会者描述了取消处方决策的重要性,这应该是一个考虑,积极主动,和计划的过程。从数据中得出了三个主题,其中心是:(1)专业态度,取消处方的能力和责任;(2)改变取消处方的文化;(3)让患者和家人/护理人员参与取消处方的决策。
结论:本研究旨在探索有责任对获得姑息治疗服务的患者做出取消处方决定的医疗保健专业人员的观点。一系列医疗保健专业人员确定了支持处方决策的重要性,所以它成为病人护理过程中的一个主动过程,而不是反应性的结果。未来的工作应该探索医疗保健专业人员如何,患者及其家人可以在取消处方的共同决策过程中得到支持.
背景:从NHS健康研究机构获得了道德批准(编号305394)。
BACKGROUND: Deprescribing has been defined as the planned process of reducing or stopping medications that may no longer be beneficial or are causing harm, with the goal of reducing medication burden while improving patient quality of life. At present, little is known about the specific challenges of decision-making to support
deprescribing for patients who are accessing palliative care. By exploring the perspectives of healthcare professionals, this qualitative study aimed to address this gap, and explore the challenges of, and potential solutions to, making decisions about deprescribing in a palliative care context.
METHODS: Semi-structured interviews were conducted with healthcare professionals in-person or via video call, between August 2022 - January 2023. Perspectives on approaches to
deprescribing in palliative care; when and how they might deprescribe; and the role of carers and family members within this process were discussed. Interviews were audio-recorded and transcribed verbatim. Reflexive thematic analysis enabled the development of themes. QSR NVivo (Version 12) facilitated data management. Ethical approval was obtained from the NHS Health Research Authority (ref 305394).
RESULTS: Twenty healthcare professionals were interviewed, including: medical consultants, nurses, specialist pharmacists, and general practitioners (GPs). Participants described the importance of
deprescribing decision-making, and that it should be a considered, proactive, and planned process. Three themes were developed from the data, which centred on: (1) professional attitudes, competency and responsibility towards deprescribing; (2) changing the culture of
deprescribing; and (3) involving the patient and family/caregivers in
deprescribing decision-making.
CONCLUSIONS: This study sought to explore the perspectives of healthcare professionals with responsibility for making deprescribing decisions with people accessing palliative care services. A range of healthcare professionals identified the importance of supporting decision-making in deprescribing, so it becomes a proactive process within a patient\'s care journey, rather than a reactive consequence. Future work should explore how healthcare professionals, patients and their family can be supported in the shared decision-making processes of deprescribing.
BACKGROUND: Ethical approval was obtained from the NHS Health Research Authority (ref 305394).