首页> 外文期刊>Scandinavian journal of primary health care. >“It is not the fading candle that one expects”: general practitioners’ perspectives on life-preserving versus “letting go” decision-making in end-of-life home care
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“It is not the fading candle that one expects”: general practitioners’ perspectives on life-preserving versus “letting go” decision-making in end-of-life home care

机译:“这不是人们所期望的褪色的蜡烛”:全科医生对寿命终止家庭护理中的生命保留和“放手”决策的看法

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Background Many general practitioners (GPs) are willing to provide end-of-life (EoL) home care for their patients. International research on GPs’ approach to care in patients’ final weeks of life showed a combination of palliative measures with life-preserving actions. Aim To explore the GP’s perspective on life-preserving versus “letting go” decision-making in EoL home care. Design Qualitative analysis of semi-structured interviews with 52 Belgian GPs involved in EoL home care. Results Nearly all GPs adopted a palliative approach and an accepting attitude towards death. The erratic course of terminal illness can challenge this approach. Disruptive medical events threaten the prospect of a peaceful end-phase and death at home and force the GP either to maintain the patient’s (quality of) life for the time being or to recognize the event as a step to life closure and “letting the patient go”. Making the “right” decision was very difficult. Influencing factors included: the nature and time of the crisis, a patient’s clinical condition at the event itself, a GP’s level of determination in deciding and negotiating “letting go” and the patient’s/family’s wishes and preparedness regarding this death. Hospitalization was often a way out. Conclusions GPs regard alternation between palliation and life-preservation as part of palliative care. They feel uncertain about their mandate in deciding and negotiating the final step to life closure. A shortage of knowledge of (acute) palliative medicine as one cause of difficulties in letting-go decisions may be underestimated. Sharing all these professional responsibilities with the specialist palliative home care teams would lighten a GP’s burden considerably. Key Points A late transition from a life-preserving mindset to one of “letting go” has been reported as a reason why physicians resort to life-preserving actions in an end-of-life (EoL) context. We investigated GPs’ perspectives on this matter. Not all GPs involved in EoL home care adopt a “letting go” mindset. For those who do, this mindset is challenged by the erratic course of terminal illness. GPs prioritize the quality of the remaining life and the serenity of the dying process, which is threatened by disruptive medical events. Making the “right” decision is difficult. GPs feel uncertain about their own role and responsibility in deciding and negotiating the final step to life closure.
机译:背景技术许多全科医生(GPs)愿意为他们的患者提供临终(EoL)家庭护理。关于全科医生在患者生命的最后几周中进行护理的方法的国际研究表明,姑息治疗与维持生命的措施相结合。目的探讨GP在EoL家庭护理中保留生命与“放手”决策的观点。对参与EoL家庭护理的52名比利时GP进行半结构式访谈的设计定性分析。结果几乎所有全科医生都采用姑息治疗方法,并对死亡采取接受态度。绝症的反复无常可以挑战这种方法。破坏性医疗事件威胁到和平期和在家中死亡的前景,并迫使全科医生暂时维持患者的(生活质量)或承认该事件是结束生命的一步并“让患者接受治疗”走”。做出“正确”的决定非常困难。影响因素包括:危机的性质和时间,事件本身的患者临床状况,全科医生在决定和谈判“放手”时的决心水平以及患者/家人对此死亡的意愿和准备情况。住院通常是一个出路。结论GP认为姑息治疗与保留生命之间的交替是姑息治疗的一部分。他们在决定和谈判结束生命的最后一步时的任务授权感到不确定。对(急性)姑息医学知识的缺乏是导致难以做出决定的原因之一,这可能被低估了。与专业的姑息性家庭护理团队共同承担所有这些专业责任,将大大减轻全科医生的负担。要点据报道,从维持生命的观念向“放手”观念的转变较晚,这是医生在临终(EoL)情况下诉诸维持生命行动的原因。我们调查了GP在此问题上的观点。并非所有参与EoL家庭护理的全科医生都采用“放手”的心态。对于那些这样做的人,这种观念受到绝症的反复无常的挑战。 GP会优先考虑剩余生命的质量和濒临死亡的过程的宁静,这将受到破坏性医疗事件的威胁。做出“正确”的决定很困难。全科医生在决定和谈判人生终结的最后一步时不确定自己的角色和责任。

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