在医院环境中谈论死亡和濒死-从患者和配偶的角度出发对生命末期谈话愿望的定性研究。
Talking about death and dying in a hospital setting - a qualitative study of the wishes for end-of-life conversations from the perspective of patients and spouses.
机构信息
Holbaek Hospital, Region Zealand, Smedelundsgade 60, 4300, Holbæk, Denmark.
REHPA, Knowledge Centre for Rehabilitation and Palliative Care, National Institute of Public Health, University of Southern Denmark, Vestergade 17, 5800, Nyborg, Denmark.
出版信息
BMC Palliat Care. 2020 Nov 2;19(1):168. doi: 10.1186/s12904-020-00675-1.
BACKGROUND
End-of-life (EOL) conversations are highly important for patients living with life-threatening diseases and for their relatives. Talking about the EOL is associated with reduced costs and better quality of care in the final weeks of life. However, there is therefore a need for further clarification of the actual wishes of patients and their relatives concerning EOL conversations in an acute hospital setting.
AIM
The purpose of this study was to explore the wishes of patients and their relatives with regard to talking about the EOL in an acute hospital setting when living with a life-threatening disease.
METHODS
This study is a qualitative study using semi-structured in-depth interviews. A total of 17 respondents (11 patients and six spouses) participated. The patients were identified by the medical staff in a medical and surgical ward using SPICT™. The interview questions were focused on the respondents' thoughts on and wishes about their future lives, as well as on their wishes regarding talking about the EOL in a hospital setting.
RESULTS
This study revealed that the wish to talk about the EOL differed widely between respondents. Impairment to the patients' everyday lives received the main focus, whereas talking about EOL was secondary. Conversations on EOL were an individual matter and ranged from not wanting to think about the EOL, to being ready to plan the funeral and expecting the healthcare professionals to be very open about the EOL. The conversations thus varied between superficial communication and crossing boundaries.
CONCLUSION
The wish to talk about the EOL in an acute hospital setting is an individual matter and great diversity exists. This individualistic stance requires the development of conversational tools that can assist both the patients and the relatives who wish to have an EOL conversation and those who do not. At the same time, staff should be trained in initiating and facilitating EOL discussions.
背景
终末期（EOL）对话对于患有危及生命疾病的患者及其亲属至关重要。谈论 EOL 与降低生命最后几周的成本和提高护理质量有关。然而，因此需要进一步澄清患者及其亲属在急性医院环境中关于 EOL 对话的实际愿望。
目的
本研究旨在探讨患有危及生命疾病的患者及其亲属在急性医院环境中谈论 EOL 的愿望。
方法
这是一项使用半结构式深入访谈的定性研究。共有 17 名受访者（11 名患者和 6 名配偶）参与。患者由医疗和外科病房的医务人员使用 SPICT™ 识别。访谈问题集中在受访者对未来生活的想法和愿望，以及他们对在医院环境中谈论 EOL 的愿望。
结果
本研究表明，受访者对谈论 EOL 的愿望差异很大。对患者日常生活的干扰是主要关注点，而谈论 EOL 则是次要关注点。EOL 的对话是个人问题，范围从不想思考 EOL，到准备规划葬礼并期望医疗保健专业人员非常开放地谈论 EOL。因此，对话从肤浅的沟通到跨越界限。
结论
在急性医院环境中谈论 EOL 的愿望是个人问题，存在很大的差异。这种个人主义立场需要开发对话工具，既可以帮助那些希望进行 EOL 对话的患者及其亲属，也可以帮助那些不希望进行 EOL 对话的患者及其亲属。同时，应培训工作人员如何发起和促进 EOL 讨论。
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