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Birinci basamakta çalışan aile hekimlerinin palyatif bakımla ilgili yaklaşımları

Year 2022, Volume: 7 Issue: 1, 13 - 17, 17.03.2022

Ufuk Ünlü , Öznur Şahin , Nagihan Yıldız Çeltek

https://doi.org/10.22391/fppc.980400

Abstract

Giriş: Bu çalışmada, birinci basamakta çalışan aile hekimlerinin palyatif bakım konusundaki farkındalıklarını saptamak, hasta ve yakınlarına karşı tutum ve davranışlarını belirlemek, yaklaşımlarını saptamak amaçlanmıştır.

Yöntem: Kesitsel ve tanımlayıcı nitelikteki araştırmanın evrenini 2020 yılı Ocak ayında Tokat’ta 194 adet aile hekimi oluşturmaktadır. Çalışmaya katılmayı kabul etmeyen 23 kişi ve belirlenen sürede ulaşılamayan 15 kişi çalışma grubunun dışında bırakılmıştır. İlgili 156 hekime ulaşılmış, hazırlanan anket formu uygulanmıştır. Araştırma için İl Sağlık Müdürlüğü’nden ve klinik araştırmalar etik kurulundan gerekli izinler alınmıştır. Veriler IBM Statistics 20.0 SPSS istatistik paket programı ile değerlendirilmiştir. Farklılıkların test edilmesinde Ki-kare testi kullanılmış, p<0,05 istatistiksel açıdan anlamlı kabul edilmiştir.

Bulgular: Çalışmaya katılan hekimlerin 98’i (%62,8) erkek, 58’i (%37,2) kadın, yaş ortalaması 40,5±9,8 olup çalışma yılı ortalaması 15,8±8,7’dir. Aile hekimliği yapanların %6,4’ü (n:10) Aile Hekimliği Uzmanları, %93,6’sı (n:146) pratisyen hekimlerden oluşmaktadır. Palyatif bakım hayatı tehdit eden hastalıklar ile ilgilenir doğru cevabını belirten katılımcıların oranı %60,3’tür.Palyatif bakım hastasına beslenme konusunda yardımcı olanların oranı %29,5(n:46) olup, psikiyatrik problemleri için destek olan 60 kişidir (%38,5). Hekimlerin %51,3’ü palyatif bakım hastalarına opioid grubu ilaç reçete etmiştir. Aile sağlığı merkezinde palyatif bakım ünitesi ile entegre şekilde hasta takip etmek isteyenlerin oranı %20,5 olup kadın hekimlerde bu oran erkeklere göre istatistiksel açıdan anlamlı derecede yüksek bulunmuştur(p:0,03).Hekimlerin %11,5’i palyatif bakım eğitimi almış, %61,5’i ise bu konuda düzenli bir eğitim almak istediğini belirtmiştir. Palyatif bakım alanında uzmanlaşmak isteyenlerin oranı %26,9’dur. Hekimlerin %74,3’ü palyatif bakım uygulamalarının aile hekimliği sisteminde performansa dahil edilmemesi gerektiğini düşünmektedir.

Sonuç: Mevcut sistemde aile hekimlerinin palyatif bakım ile ilgili yeterli eğitime ve donanıma sahip olmadıkları saptanmıştır. Birinci basamakta giderek artan palyatif bakım ihtiyacına paralel olarak bu alanda bir takım güncel düzenlemeler yapılması ve hizmet içi eğitimlerin gündeme getirilmesi gereklidir.

Anahtar Kelimeler: Aile hekimliği, palyatif bakım, ağrı, opioid analjezikler, palyatif bakım eğitimi

Keywords

Aile hekimliği Palyatif bakım ağrı opioid analjezikler palyatif bakım eğitimi

References

  • 1. http://www.who.int/cancer/palliative/definition/en/ (Accessed 01 March 2022)
  • 2. Aydogan F, Uygun K. [Palliative treatments in Cancer Patients] (in Turkish). Klinik Gelişim. 2011; 24: 4-9.
  • 3. Kabalak AA. Palliative care studies in Turkey. Turkiye Klinikleri J Anest Reanim-Special Topics. 2017;10(1):7-12.
  • 4. Ozgul N, Gultekin M, Koc O, Goksel F, Bayraktar G, Ekinci H et al. Turkish community-based palliative care model: a unique design. Annals of Oncology.2012; 23 (3): 76–8. https://doi.org/10.1093/annonc/mds093
  • 5. https://khgmozellikli.saglik.gov.tr/svg/palyatif.php (Accessed 01 March 2022)
  • 6. Miniksar OH, Korkmaz Disli Z, Tunc Z, Acun Delen L, Honca M. Determination of knowledge and opinions on palliative care of workers in intensive care and palliative care units: a survey study J Tradit Complem Med. 2020;3(1):61-8. https://doi.org/10.5336/jtracom.2019-72380
  • 7. Yildizer OF, Ogur S. Knowledge and attitudes of health personnel on palliative care: sample of Bitlis province. J Curr Res Health Sector. 2018; 8 (2), 411-38.
  • 8. Bag B. [Palliative care practices in the health system in the case of Germany] (in Turkish). Turk J Oncol. 2012; 27 (3): 142-9. https://doi.org/10.5505/tjoncol.2012.687
  • 9. Tanriverdi O, Yavuzsen T, Akman T, Senler FC, Taskoylu BY, Turhal S et al. The Perspective of non-oncologist physicians on patients with metastatic cancer and palliative care (ALONE Study):a study of the palliative care working committee of the Turkish oncology group (TOG). J Canc Educ 2015; 30:253–9. https://doi.org/10.1007/s13187-015-0794-3
  • 10. Pelayo M, Cebrian D, Areosa A, Agra Y, Izquierdo JV, Buendia F. Effects of online palliative care training on knowledge, attitude and satisfaction of primary care physicians. BMC Fam Pract.2011; 12:37–47. https://doi.org/10.1186/1471-2296-12-37
  • 11. Demir M. Palliative care ethics: Turk J Med Surg Intens Care Med.2016; 7: 62-6. https://doi.org/10.5152/dcbybd.2016.1202
  • 12. Uyar M, Cetingok H, Ozyalcin SN. Chronic pain and access to treatment at the end of life. Comm Physician. 2016; 31(1): 18-24.
  • 13. Benli AR, Erbesler ZA. Differences on comprehension and practice in palliative care in Turkey. Turk J Fam Pract 2016; 20 (1): 5-6. https://doi.org/10.15511/tahd.15.21605
  • 14. Celtek NY, Okan I. [Patient evaluation and scales in palliative care] (in Turkish). Clin Med J Fam Med. 2016; 8(3): 6-11.
  • 15. Dirimen Arikan G. Definition and philosophy of palliative care. Clin Med J Fam Med. 2016; 8(3):1-5.
  • 16. Vinay P. Rebuttal: should palliative care be a specialty?: no. Can Fam Physician. 2008 ;54(7):974-7.
  • 17. Thoonsen B, Gerritzen SHM, Vissers KCP, et al. Training general practitioners contributes to the identification of palliative patients and to multidimensional care provision: secondary outcomes of an RCT. BMJ Support Palliat Care. 2019;9(1):e18. https://doi.org/10.1136/bmjspcare-2015-001031

Approaches of family physicians working in primary care regarding palliative care

Year 2022, Volume: 7 Issue: 1, 13 - 17, 17.03.2022

Ufuk Ünlü , Öznur Şahin , Nagihan Yıldız Çeltek

https://doi.org/10.22391/fppc.980400

Abstract

Introduction: Determining the awareness of family physicians working in primary care about palliative care, to determine their attitudes and behaviors towards patients and their relatives, and their approaches are aimed in this study.

Methods: The universe of the cross-sectional and descriptive study consists of 194 family physicians in Tokat in January 2020. However 23 physicians who refuse to participate and 15 physicians who could not reached in detected dates were excluded from the study. 156 physicians were applied prepared questionnaire. The necessary permissions were obtained from the Provincial Health Directorate and the clinical research ethics committee. The data were evaluated with IBM Statistics 20.0 SPSS statistical software. Chi-square test was used to test the differences, and p <0.05 was accepted statistically significant.

Results: Regarding participants 98 (62,8%)were male, 58 (37,2 %) female, mean age 40,5±9,8 and mean working years 15,8. 6.4% (n: 10) of the participants were family medicine specialists and 93.6% (n: 146) general practitioners. The proportion of respondents who state the correct answer as ‘palliative care deals with life-threatening diseases’ was 60.3%. The proportion of those who helped palliative care patients about nutrition was 29.5% (n: 46) and 60 physicians supported for psychiatric problems (38.5%). 51.3% of the physicians prescribed opioid group drugs. The rate of those who want to follow patients in the family health center as integrated with the palliative care units 20.5%, and this rate was found to be statistically significantly higher in female physicians (p: 0.03). 11.5% of the physicians received palliative care training, while 61.5% stated that they wanted to receive regular training in this regard.26.9 % of participants want to specialize in palliative care. 74.3% of physicians think that palliative care practices should not be included into performance system in the family medicine practices.

Conclusions: In the current system, it was found that family physicians did not have sufficient training and equipment related to palliative care. In line with the increasing need for palliative care in primary care, some up-to-date arrangements and in-service trainings should be brought to the agenda.

Keywords: Family practice, palliative care, pain, opioid analgesics, palliative care training

Keywords

Family practice palliative care pain opioid analgesics palliative care training

References

  • 1. http://www.who.int/cancer/palliative/definition/en/ (Accessed 01 March 2022)
  • 2. Aydogan F, Uygun K. [Palliative treatments in Cancer Patients] (in Turkish). Klinik Gelişim. 2011; 24: 4-9.
  • 3. Kabalak AA. Palliative care studies in Turkey. Turkiye Klinikleri J Anest Reanim-Special Topics. 2017;10(1):7-12.
  • 4. Ozgul N, Gultekin M, Koc O, Goksel F, Bayraktar G, Ekinci H et al. Turkish community-based palliative care model: a unique design. Annals of Oncology.2012; 23 (3): 76–8. https://doi.org/10.1093/annonc/mds093
  • 5. https://khgmozellikli.saglik.gov.tr/svg/palyatif.php (Accessed 01 March 2022)
  • 6. Miniksar OH, Korkmaz Disli Z, Tunc Z, Acun Delen L, Honca M. Determination of knowledge and opinions on palliative care of workers in intensive care and palliative care units: a survey study J Tradit Complem Med. 2020;3(1):61-8. https://doi.org/10.5336/jtracom.2019-72380
  • 7. Yildizer OF, Ogur S. Knowledge and attitudes of health personnel on palliative care: sample of Bitlis province. J Curr Res Health Sector. 2018; 8 (2), 411-38.
  • 8. Bag B. [Palliative care practices in the health system in the case of Germany] (in Turkish). Turk J Oncol. 2012; 27 (3): 142-9. https://doi.org/10.5505/tjoncol.2012.687
  • 9. Tanriverdi O, Yavuzsen T, Akman T, Senler FC, Taskoylu BY, Turhal S et al. The Perspective of non-oncologist physicians on patients with metastatic cancer and palliative care (ALONE Study):a study of the palliative care working committee of the Turkish oncology group (TOG). J Canc Educ 2015; 30:253–9. https://doi.org/10.1007/s13187-015-0794-3
  • 10. Pelayo M, Cebrian D, Areosa A, Agra Y, Izquierdo JV, Buendia F. Effects of online palliative care training on knowledge, attitude and satisfaction of primary care physicians. BMC Fam Pract.2011; 12:37–47. https://doi.org/10.1186/1471-2296-12-37
  • 11. Demir M. Palliative care ethics: Turk J Med Surg Intens Care Med.2016; 7: 62-6. https://doi.org/10.5152/dcbybd.2016.1202
  • 12. Uyar M, Cetingok H, Ozyalcin SN. Chronic pain and access to treatment at the end of life. Comm Physician. 2016; 31(1): 18-24.
  • 13. Benli AR, Erbesler ZA. Differences on comprehension and practice in palliative care in Turkey. Turk J Fam Pract 2016; 20 (1): 5-6. https://doi.org/10.15511/tahd.15.21605
  • 14. Celtek NY, Okan I. [Patient evaluation and scales in palliative care] (in Turkish). Clin Med J Fam Med. 2016; 8(3): 6-11.
  • 15. Dirimen Arikan G. Definition and philosophy of palliative care. Clin Med J Fam Med. 2016; 8(3):1-5.
  • 16. Vinay P. Rebuttal: should palliative care be a specialty?: no. Can Fam Physician. 2008 ;54(7):974-7.
  • 17. Thoonsen B, Gerritzen SHM, Vissers KCP, et al. Training general practitioners contributes to the identification of palliative patients and to multidimensional care provision: secondary outcomes of an RCT. BMJ Support Palliat Care. 2019;9(1):e18. https://doi.org/10.1136/bmjspcare-2015-001031
There are 17 citations in total.

Details

Primary Language English
Subjects ​Internal Diseases
Journal Section Original Research
Authors

Ufuk Ünlü 0000-0001-7995-0866

Öznur Şahin 0000-0001-9570-9415

Nagihan Yıldız Çeltek 0000-0003-2145-9825

Publication Date March 17, 2022
Submission Date August 9, 2021
Acceptance Date December 31, 2021
Published in Issue Year 2022 Volume: 7 Issue: 1

Cite

APA Ünlü, U., Şahin, Ö., & Yıldız Çeltek, N. (2022). Approaches of family physicians working in primary care regarding palliative care. Family Practice and Palliative Care, 7(1), 13-17. https://doi.org/10.22391/fppc.980400
AMA Ünlü U, Şahin Ö, Yıldız Çeltek N. Approaches of family physicians working in primary care regarding palliative care. Fam Pract Palliat Care. March 2022;7(1):13-17. doi:10.22391/fppc.980400
Chicago Ünlü, Ufuk, Öznur Şahin, and Nagihan Yıldız Çeltek. “Approaches of Family Physicians Working in Primary Care Regarding Palliative Care”. Family Practice and Palliative Care 7, no. 1 (March 2022): 13-17. https://doi.org/10.22391/fppc.980400.
EndNote Ünlü U, Şahin Ö, Yıldız Çeltek N (March 1, 2022) Approaches of family physicians working in primary care regarding palliative care. Family Practice and Palliative Care 7 1 13–17.
IEEE U. Ünlü, Ö. Şahin, and N. Yıldız Çeltek, “Approaches of family physicians working in primary care regarding palliative care”, Fam Pract Palliat Care, vol. 7, no. 1, pp. 13–17, 2022, doi: 10.22391/fppc.980400.
ISNAD Ünlü, Ufuk et al. “Approaches of Family Physicians Working in Primary Care Regarding Palliative Care”. Family Practice and Palliative Care 7/1 (March2022), 13-17. https://doi.org/10.22391/fppc.980400.
JAMA Ünlü U, Şahin Ö, Yıldız Çeltek N. Approaches of family physicians working in primary care regarding palliative care. Fam Pract Palliat Care. 2022;7:13–17.
MLA Ünlü, Ufuk et al. “Approaches of Family Physicians Working in Primary Care Regarding Palliative Care”. Family Practice and Palliative Care, vol. 7, no. 1, 2022, pp. 13-17, doi:10.22391/fppc.980400.
Vancouver Ünlü U, Şahin Ö, Yıldız Çeltek N. Approaches of family physicians working in primary care regarding palliative care. Fam Pract Palliat Care. 2022;7(1):13-7.
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Family Practice and Palliative Care       ISSN 2458-8865       E-ISSN 2459-1505