Aims

For patients with advanced cancer, early access to palliative care can have numerous psychosocial and disease management benefits. However, it can be difficult for clinicians to initiate these initial conversations about palliative care. The aim of the present study was to beta test an intervention to facilitate timely conversations about palliative care between patients and clinicians.

Materials and methods

The study reported forms one stage of a complex intervention development study following Medical Research Council guidance for developing complex interventions. Feasibility was explored from patient and clinician perspectives in an oncology outpatient setting.

Results

Sixteen patients and 18 clinicians participated. Three phases of the intervention were assessed through patient and clinician interviews. The analysis produced three themes in each phase: (i) Preparation (patient preparedness; healthcare professionals' perspectives on palliative care; administration, data and communication); (ii) STEP consultation (defining perspectives on palliative care; how palliative care fits with the current treatment plan; permission to explore future care); (iii) Outcomes (changes in perspective and approaches to coping; opening the door to future conversations; referrals and involvement of palliative services).

Conclusions

The STEP intervention generated important early conversations about end-of-life care that may otherwise not have occurred. No patients regretted having the STEP consultation, which resulted in palliative care referrals for some. Others felt better informed about the support services available and better able to have further conversations. Participating clinicians found the structured conversation guide useful, as it acted as a prompt for areas to cover, as well as providing an explicit way to open discussion about difficult topics.

中文翻译：

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支持肿瘤患者早期姑息治疗对话的结构化干预——一项定性可行性研究

宗旨

对于晚期癌症患者，及早获得姑息治疗可以带来许多社会心理和疾病管理方面的好处。然而，临床医生可能很难发起这些关于姑息治疗的初步对话。本研究的目的是对一项干预措施进行 Beta 测试，以促进患者和临床医生之间关于姑息治疗的及时对话。

材料和方法

该研究报告构成了复杂干预开发研究的一个阶段，遵循医学研究委员会关于开发复杂干预措施的指南。在肿瘤科门诊环境中，从患者和临床医生的角度探讨了可行性。

结果

16 名患者和 18 名临床医生参加了研究。通过患者和临床医生访谈评估干预的三个阶段。该分析在每个阶段产生了三个主题：(i) 准备（患者准备；医疗保健专业人员对姑息治疗的看法；管理、数据和沟通）；(ii) STEP 咨询（定义姑息治疗的观点；姑息治疗如何适应当前的治疗计划；允许探索未来的治疗）；(iii) 结果（改变观点和应对方法；打开未来对话的大门；转介和参与姑息治疗）。

结论

STEP 干预产生了关于临终关怀的重要早期对话，否则这些对话可能不会发生。没有患者后悔接受 STEP 咨询，这导致一些患者转诊姑息治疗。其他人则感觉更好地了解可用的支持服务，并且能够更好地进行进一步的对话。参与的临床医生发现结构化对话指南很有用，因为它可以提示要涵盖的领域，并提供一种明确的方式来公开讨论困难的话题。