Kramer Betty J, Yonker James A
School of Social Work, University of Wisconsin-Madison, Madison, Wisconsin, USA.
Department of Sociology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA.
J Pain Symptom Manage. 2011 Jan;41(1):35-48. doi: 10.1016/j.jpainsymman.2010.04.017. Epub 2010 Sep 15.
The purpose of this study was to examine the predictors of perceived success in addressing the end-of-life care needs of low-income older adults and their family members. Perceived success is defined as the clinician's subjective assessment of the extent to which end-of-life care needs of the patient and family have been met by the interdisciplinary team. The results are drawn from a larger longitudinal multimethod case study designed to understand how end-of-life care is provided to a diverse group of frail elders in an innovative, fully "integrated," managed care program. Data were generated from 120 social work surveys detailing care experiences and outcomes particular to 120 elder deaths. Significant predictors of perceived success for addressing patient needs included patient care needs (β=0.17, P≤0.05), race (β=0.19, P≤0.05), patient preferences elicited (β=0.29, P≤0.01) and honored (β=0.20, P≤0.05), and family conflict (β=-0.24, P≤0.01). Significant predictors of perceived success for addressing family needs included family care needs (β=0.30, P≤0.001), team and administrative resources (β=0.19, P≤0.01), patient preferences honored (β=0.16, P≤0.05), quality of relationship with patient (β=0.27, P≤0.001) and family (β=0.23, P≤0.01), and family conflict (β=-0.31, P≤0.001). This study provides preliminary evidence of differential correlates and predictors of perceived success for addressing patient and family needs, highlighting the detrimental influence of family conflict. Future research is needed to better understand the kinds of assessment and intervention protocols that might prevent or ameliorate conflict and enhance structures and process-of-care variables to facilitate more successful outcomes.
本研究的目的是探讨在满足低收入老年人及其家庭成员临终关怀需求方面，感知成功的预测因素。感知成功被定义为临床医生对跨学科团队满足患者及其家庭临终关怀需求程度的主观评估。研究结果来自一项规模更大的纵向多方法案例研究，该研究旨在了解在一个创新的、完全“整合”的管理式护理项目中，如何为不同类型的体弱老年人提供临终关怀。数据来自120份社会工作调查，详细记录了120例老年人死亡的护理经历和结果。满足患者需求的感知成功的显著预测因素包括患者护理需求（β=0.17，P≤0.05）、种族（β=0.19，P≤0.05）、引出的患者偏好（β=0.29，P≤0.01）并得到尊重（β=0.20，P≤0.05），以及家庭冲突（β=-0.24，P≤0.01）。满足家庭需求的感知成功的显著预测因素包括家庭护理需求（β=0.30，P≤0.001）、团队和行政资源（β=0.19，P≤0.01）、得到尊重的患者偏好（β=0.16，P≤0.05）、与患者的关系质量（β=0.27，P≤0.001）和与家庭的关系质量（β=0.23，P≤0.01），以及家庭冲突（β=-0.31，P≤0.001）。本研究为满足患者和家庭需求的感知成功的不同相关因素和预测因素提供了初步证据，突出了家庭冲突的不利影响。需要进一步的研究来更好地理解可能预防或缓解冲突的评估和干预方案类型，并加强护理结构和过程变量，以促进更成功的结果。
