Resnick Helaine E, Foster Gregory L, Hickman Susan E
Institute for the Future of Aging Services, American Association of Homes and Services for the Aging, Washington, DC 20008, USA.
Am J Hosp Palliat Care. 2009 Oct-Nov;26(5):354-60. doi: 10.1177/1049909109333933. Epub 2009 Apr 14.
The purpose of this report is to define the extent to which US nursing homes (NH) participate in end-of-life programs, using a nationally representative, cross-sectional sample of US NH. Data on EoL programs including Five Wishes, Last Acts, and Physician Orders for Life-Sustaining Treatment (POLST) were collected. In 2004, 17.2% of NH reported participating in 1 or more of these programs, with the largest proportion participating in POLST (13.3%) and smaller proportions in Five Wishes (5.6%) and Last Acts (4.2%). Nursing homes were more likely to participate in EoL programs if they also offered specialty programs and staff training for hospice, end-of-life, pain management, and dementia services. In 2004, fewer than 1 in 5 US NH participated in an EoL program. However, facilities that had EoL programs were more likely to have programs and staff training for services related to EoL care, a finding that suggests a clustering of these programs, services, and training. Provision of appropriate staff training may be a key to expanding EoL program participation in skilled nursing.
本报告旨在利用美国疗养院具有全国代表性的横断面样本，确定美国疗养院（NH）参与临终关怀项目的程度。收集了包括《五个愿望》《最后行动》和《维持生命治疗的医生医嘱》（POLST）等临终关怀项目的数据。2004年，17.2%的疗养院报告参与了这些项目中的1个或更多项目，参与比例最高的是POLST（13.3%），参与《五个愿望》（5.6%）和《最后行动》（4.2%）的比例较小。如果疗养院还提供临终关怀、临终、疼痛管理和痴呆症服务的专业项目及员工培训，那么它们更有可能参与临终关怀项目。2004年，美国每5家疗养院中参与临终关怀项目的不到1家。然而，设有临终关怀项目的机构更有可能设有与临终关怀护理相关服务的项目及员工培训，这一发现表明这些项目、服务和培训存在聚集现象。提供适当的员工培训可能是扩大熟练护理机构参与临终关怀项目的关键。
