非恶性慢性病患者转诊到专科姑息治疗:加纳一家教学医院的研究

International Journal of Chronic Diseases Pub Date : 2020-03-15 eCollection Date: 2020-01-01 DOI:10.1155/2020/8432956
Rasheed Ofosu-Poku, Michael Owusu-Ansah, John Antwi
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引用次数: 13

摘要

加纳的慢性病负担正在上升。慢性疾病管理临床护理的一个重要方面是提高患者及其家属的生活质量,并帮助他们应对限制生命的疾病的经历。专科姑息治疗服务有助于实现这一目标,特别是在复杂的社会心理挑战和高症状负担的背景下。因此,有必要让尽可能多的患者获得现有的专科姑息治疗服务。本文探讨影响非恶性慢性病患者转诊接受专科姑息治疗的因素。采用定性方法从八(8)名参与者(四(4)名内科专家和四(4)名晚期非恶性慢性疾病患者的近亲)中探讨这些因素。个人面对面访谈采用半结构化访谈指南进行。对访谈进行录音和数据编码,确定主题和分主题,并进行主题分析。确定的障碍和激励因素被归类为与医生、机构或家庭有关。转诊的障碍是对姑息治疗范围的认识、医疗家长式作风、缺乏机构转诊政策、姑息治疗团队人力资源能力差,以及缺乏对专科姑息治疗服务存在的认识。患者和家庭经济状况不佳、预后不佳、以前与姑息治疗团队的互动以及对患者对医疗保健系统的期望的赞赏被确定为转诊的动机。因此,姑息治疗团队必须提高其他卫生专业人员对其服务的认识,并促进制定和提供明确的政策,以指导和改善转诊。
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Referral of Patients with Nonmalignant Chronic Diseases to Specialist Palliative Care: A Study in a Teaching Hospital in Ghana.

Ghana's chronic disease burden is on the rise. An essential aspect of clinical care in chronic disease management is to improve the quality of life of both patients and their families and to help them cope with the experience of life-limiting illness. Specialist palliative care services help reach this objective, especially in the context of complex psychosocial challenges and high symptom burden. It is, therefore, necessary that as many patients as possible get access to available specialist palliative care services. This paper explores the factors influencing referral of patients with nonmalignant chronic diseases for specialist palliative care. A qualitative approach was used to explore these factors from eight (8) participants-four (4) physician specialists and four (4) next of kin of patients with advanced nonmalignant chronic illness. Individual face-to-face interviews were conducted using a semistructured interview guide. Interviews were audio-recorded and data coded, themes and subthemes were identified, and thematic analysis was done. Barriers and motivators identified were categorized as either related to physicians, institution, or family. Barriers to referral were perception of the scope of palliative care, medical paternalism, lack of an institutional referral policy, poor human resource capacity of the palliative care team, and lack of awareness about the existence of specialist palliative care service. Poor economic status of the patient and family, poor prognosis, previous interaction with the palliative care team, and an appreciation of patients' expectations of the healthcare system were identified as motivators for referral. The palliative care team must therefore increase awareness among other health professionals about their services and facilitate the development and availability of a clear policy to guide and improve referrals.

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