Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, WA, USA.
J Gen Intern Med. 2010 Oct;25(10):1009-19. doi: 10.1007/s11606-010-1423-9. Epub 2010 Jun 10.
United States hospice organizations aim to provide quality, patient-centered end-of-life care to patients in the last 6 months of life, yet some of these organizations observe that some hospice-eligible patients who are referred to hospice do not initially enroll.
To identify reasons that eligible patients do not enroll in hospice (phase 1).
To identify strategies used by hospice providers to address these reasons (phase 2).
Semi-structured interviews analyzed using content analysis.
In phase 1, we interviewed 30 patients and/or family members of patients who had a hospice admissions visit, but who did not enroll. In phase 2, we interviewed 19 hospice staff and national experts.
In phase 1, we asked participants to describe the patient's illness, the hospice referral, and why they had not enrolled. We performed a content analysis to characterize their reasons for not enrolling in hospice. In phase 2, we enrolled hospice admissions staff and hospice experts. We asked them to describe how they would respond to each reason (from phase 1) during an admissions visit with a potential new hospice patient. We identified key phrases, and summarized their recommendations.
Reasons that patients hadn't enrolled fell into three broad categories: patient/family perceptions (e.g., "not ready"), hospice specific issues (e.g., variable definitions of hospice-eligible patients), and systems issues (e.g., concerns about continuity of care). Hospice staff/experts had encountered each reason, and offered strategies at the individual and organizational level for responding.
In hopes of increasing hospice enrollment among hospice-eligible patients, non-hospice and hospice clinicians may want to adopt some of the strategies used by hospice staff/experts for talking about hospice with patients/families and may want to familiarize themselves with the differences between hospice organizations in their area. Hospices may want to reconsider their admission policies and procedures in light of patients' and families' perceptions and concerns.
美国的临终关怀组织旨在为生命最后 6 个月的患者提供优质、以患者为中心的临终关怀，但这些组织中的一些注意到，一些被转介到临终关怀的符合条件的患者最初并没有登记。
确定符合条件的患者没有登记入住临终关怀的原因（第 1 阶段）。
确定临终关怀提供者用来解决这些问题的策略（第 2 阶段）。
使用内容分析法分析半结构化访谈。
在第 1 阶段，我们采访了 30 名患者和/或患者的家属，他们有过临终关怀入院访问，但没有登记。在第 2 阶段，我们采访了 19 名临终关怀工作人员和国家专家。
在第 1 阶段，我们要求参与者描述患者的疾病、临终关怀转介以及他们没有登记的原因。我们进行了内容分析，以描述他们不登记入住临终关怀的原因。在第 2 阶段，我们招募了临终关怀入院工作人员和临终关怀专家。我们让他们描述在与潜在的新临终关怀患者进行入院访问时，他们将如何应对每个原因（来自第 1 阶段）。我们确定了关键短语，并总结了他们的建议。
患者没有登记的原因分为三大类：患者/家庭的看法（例如，“还没准备好”）、临终关怀的具体问题（例如，符合条件的临终关怀患者的定义不同）和系统问题（例如，对护理连续性的担忧）。临终关怀工作人员/专家已经遇到了每个原因，并在个人和组织层面上提出了应对策略。
为了增加符合条件的临终关怀患者的登记入住率，非临终关怀和临终关怀临床医生可能希望采用临终关怀工作人员/专家在与患者/家庭谈论临终关怀时使用的一些策略，并熟悉他们所在地区临终关怀组织之间的差异。临终关怀机构可能希望根据患者和家属的看法和担忧，重新考虑他们的入院政策和程序。
