Physicians’Perception of Palliative Care Consultation Service in a Major General Hospital in China

Objectives The in-hosptial palliative care consultation(PCC) is emerging as a routine service in some medical center in China. The current study evaluated how physicians in primary care team and consultation team perceive the PCC service for the purpose of investigating the effectiveness of this consultation model in a general hospital.Methods In-hosptial palliative care consultations have been carried out at Peking Union Medical College Hosptial by a dedicated consultation team, and 37 consultations were completed in 2016. A questionnaire was designed for physicians in terms of its benefits to patients,their family as well as the primary care team. Physicians who applied for consultation in 2016 formally(requested from the department other than the Geriatrics) and informally(by rotating residents and unemployed visiting doctors in geriatric department) were invited to participate in the survey by scanning a two dimentional code on social networking platform.Results There were 103 physicians participated in the survey, including primary care physicians from the department of Internal Medicine(n=8), Gynaecology(n=16) and Surgery(n=13), rotating residents(n=30), visiting doctors(n=16) in Geriatric department, and PCC team members(n=20). 94.0% of the non-PCC physicians agreed that PCC relieved the suffering of patients; 89.2% thought PCC improved the quality of patients' life; there were 91.6%, 95.2%, 90.4% physicians who felt it relieved the anxiety of patients, of family members and of care providers, respectively. There were 96.4% physicians who felt it could ease the tension in physician-patient relationship; 97.6% felt it lower the risk for medical negligence, and 96.4% of doctors who applied for PPC felt satisfied with PCC service in terms of process and achieving objectives of consultation. More primary-team physician agree "PCC service helps the physicians better understand palliative care" than PCC members(97.6% vs. 80%, P<0.05), while both were interested in learning more on palliative medicine(100% vs. 96.4%, P>0.05).Conclusion Palliative care consultation service in a general hospital is efficacious and acclaimed.The primary care physicians and the PCC members hold positive attitudes to the benefits that the PCC services bring to patients, family members, and physicians themselves. PCC for terminal patients in a general hospital may serve as a good modle for promotion of palliative care in China.

Palliative Care in Emergency Medicine. What Are We Missing?

Patients present to the emergency department with critical and complex medical conditions that require a broad scope of medicine to achieve patient outcomes. Emergency medicine physicians are recognizing the importance and positive outcomes that arise when palliative care teams are consulted in the emergency room. Today, medical schools, residency programs, and emergency departments are requiring palliative care curriculum apart of their education. However, there continues to be a gap in early initiation of palliative care in emergency medicine. Nurse practitioners are becoming pivotal in the emergency department, and patients are considering them key providers in their medical journey. The role of an advanced practice nurse in an emergency room may be optimal for the early onset of palliative care consultation. This manuscript examines current knowledge that explores the background of palliative care, the current practice in the emergency department, the positive outcomes and gaps that still exist today, and the increasing role of an advanced practice nurse in the emergency room and their impact on palliative care initiation.

发展缓和医疗理念和实践后终末期患者死亡状况变化

目的 北京协和医院国际医疗部于2016年开始逐步推行缓和医疗理念和实践,本研究旨在对该理念推广前后终末期患者死亡状况进行分析,以评估缓和医疗对终末期患者死亡质量的影响。方法 回顾性收集北京协和医院国际医疗部2013年和2019年死亡的终末期患者的临床资料,对其临终前诊疗细节进行比较。结果 共入选符合纳入与排除标准的2013年终末期患者36例、2019年终末期患者37例。2013年患者中,男性19例、女性17例,平均年龄(72.1±14.0)岁,晚期肿瘤19例。2019年患者中,男性19例、女性18例,平均年龄(70.8±15.3)岁,晚期肿瘤27例。相较于2013年患者,2019年患者临终前转入ICU(0比22.2%,P=0.008)、接受心肺复苏(0比16.7%,P=0.011)、气管插管(5.4%比36.1%,P=0.001)、有创机械通气(2.7%比33.3%,P=0.001)、全肠外营养(32.4%比61.1%,P=0.014)的比例均降低,接受缓和医疗会诊(29.7%比0,P<0.001)、得到人文关怀(40.5%比16.7%,P=0.024)的比例均升高。2019年患者中,相较于未接受缓和医疗会诊患者,接受缓和医疗会诊者得到人文关怀的比例更高(90.9%比19.2%,P<0.001)。结论缓和医疗理念推广和实践后北京协和医院国际医疗部终末期患者死亡前接受有创治疗的比例明显降低,得到人文关怀的比例显著提高,死亡质量得到一定提升。

终末期患者缓和医疗共同管理模式

缓和医疗共同管理是指缓和医疗团队在患者病程早期进行缓和医学干预,与患者的主治团队共同给予照护。通过阅读文献,结合国外医疗机构共管经验,笔者认为共管模式能够更有效地利用现有资源,给予患者原治疗团队缓和医疗技术上的支持,为患者带来更高的生命质量。各医疗单位需要根据自身条件,选择合适的共同照护模式,而缓和医疗团队需要与各科室建立长久持续的合作关系,才能为患者带来更安全有效的医疗体验。

叙事缓和医疗会诊案例与分析--“缓和医疗10年”笔谈成果之三

研究团队致力于将缓和医疗与叙事医学两个学科领域进行深度融合。界定了“痛点”概念,即在生物医学实践中,医务人员遭遇心理困惑、目标模糊、无计可施的状态。在界定概念的基础上,以疏通“痛点”为临床操作的“密码”,结合缓和医疗会诊案例,探讨叙事医学的临床实践问题。案例以医生的口述原文结合注释解析的形式呈现,进而提出识别痛苦、建立关系、以叙事能力疏通“痛点”的叙事医学临床实践步骤,旨在以缓和医疗领域为例,预期对其他医学领域的叙事医学实践形成借鉴。

北京协和医院急诊缓和医疗会诊实践

目的对北京协和医院急诊科发起的缓和医疗会诊进行总结梳理。方法回顾性分析2017年1月至2020年6月北京协和医院急诊科提出的22次缓和医疗会诊资料。结果共18例患者接受缓和医疗会诊,其中,男6例,女12例,平均年龄(65±8)岁(36~88岁);10例患者会诊1次,6例患者会诊2次,2例患者未完成会诊;15例患者为恶性肿瘤,3例患者为非肿瘤性疾病。会诊原因中,61.1%(11/18)是关于沟通;61.1%(11/18)是减轻患者的痛苦症状。离世地点方面,8例在本院离世,6例在其他医疗机构离世。结论北京协和医院急诊对缓和医疗会诊存在明确需求,会诊能给急诊医患双方带来帮助。

北京协和医院院内缓和医疗会诊对医护人员的影响

目的探讨北京协和医院院内缓和医疗会诊对请求过缓和医疗会诊医护人员的影响。方法对17名请求过缓和医疗会诊的医护人员进行半结构式访谈。结果缓和医疗会诊对医护人员的正面影响有:可以搭建医患沟通的桥梁,拉近医患之间的距离;给予医护人员心理支持,减少职业耗竭感;给予医护人员技术支持,从而帮助患者缓解症状;实现跨学科的交流与学习;弥补传统医疗缺乏的人文关怀以及重拾被忽视的医学伦理问题的作用。结论三甲医院内缓和医疗会诊对提高医护人员服务末期病患的品质意义重大,现有的缓和医疗会诊服务能力亟待提升。

三甲医院缓和医疗会诊服务实践存在的问题分析

目的探究三甲医院院内缓和医疗会诊服务在实践过程中遇到的障碍,针对这些困难提出意见和建议,为院内缓和医疗会诊服务的进一步开展提供参考。方法对北京协和医院17名请求过缓和医疗会诊服务的医护人员进行半结构式访谈,对相关资料进行整理、分析。结果院内缓和医疗会诊服务开展中的障碍因素包括患者及家属对缓和医疗了解不够深入、医护人员对缓和医疗的认知不够深刻、临床诊疗团队对会诊意见落实不够全面、缓和医疗会诊团队提供服务的精力有限、缓和医疗的开展难以创造所谓的经济效益5个方面。同时,针对院内缓和医疗会诊服务开展过程中的障碍和不足,提出工作改进的建议包括增加患者及其家属对缓和医疗的接受程度、提高医护人员对缓和医疗知识水平、建立会诊团队与医护人员的新型合作模式、增强医院对缓和医疗发展的制度保障和建立健全缓和医疗相关法律政策等。结论三甲医院院内缓和医疗会诊服务在实践过程中虽然遇到很多困难和障碍,但是医护人员对缓和医疗的需求和期望仍在提高。

安宁疗护咨询在危重症患者中的应用进展

ICU与安宁疗护的结合,有助于提高ICU患者的生命质量,减少过度医疗。ICU安宁疗护咨询是以ICU临终患者和家属为中心,由安宁疗护咨询者提供有关症状控制、医疗决策制订和安宁疗护转诊信息的共享照护实践,是整合安宁疗护和ICU护理的有效途径。该文对ICU安宁疗护咨询的概念和内容、实施效果及障碍进行综述,为国内ICU开展安宁疗护咨询提供参考。