Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute, King's College London, Bessemer Road, Denmark Hill, London, UK.
BMC Geriatr. 2011 Jun 9;11:31. doi: 10.1186/1471-2318-11-31.
An increasing number of older people reach the end of life in care homes. The aim of this study is to explore the perceived benefits of, and barriers to, implementation of the Gold Standards Framework for Care Homes (GSFCH), a quality improvement programme in palliative care.
Nine care homes involved in the GSFCH took part. We conducted semi-structured interviews with nine care home managers, eight nurses, nine care assistants, eleven residents and seven of their family members. We used the Framework approach to qualitative analysis. The analysis was deductive based on the key tasks of the GSFCH, the 7Cs: communication, coordination, control of symptoms, continuity, continued learning, carer support, and care of the dying. This enabled us to consider benefits of, and barriers to, individual components of the programme, as well as of the programme as a whole.
Perceived benefits of the GSFCH included: improved symptom control and team communication; finding helpful external support and expertise; increasing staff confidence; fostering residents' choice; and boosting the reputation of the home. Perceived barriers included: increased paperwork; lack of knowledge and understanding of end of life care; costs; and gaining the cooperation of GPs. Many of the tools and tasks in the GSFCH focus on improving communication. Participants described effective communication within the homes, and with external providers such as general practitioners and specialists in palliative care. However, many had experienced problems with general practitioners. Although staff described the benefits of supportive care registers, coding predicted stage of illness and advance care planning, which included improved communication, some felt the need for more experience of using these, and there were concerns about discussing death.
Most of the barriers described by participants are relevant to other interventions to improve end of life care in care homes. There is a need to investigate the impact of quality improvement programmes in care homes, such as the GSFCH, on a wider range of outcomes for residents and their families, and to monitor the sustainability of any resulting improvements. It is also important to explore the impact of the different components of these complex interventions.
越来越多的老年人在养老院中度过生命的最后阶段。本研究旨在探讨金标准框架（GSFCH）在养老院姑息治疗中的实施所带来的益处和面临的障碍，该框架是一个质量改进计划。
有 9 家参与 GSFCH 的养老院参与了这项研究。我们对 9 名养老院经理、8 名护士、9 名护理助理、11 名居民及其 7 名家属进行了半结构化访谈。我们采用了框架分析法，分析是基于 GSFCH 的关键任务和 7C 原则（沟通、协调、症状控制、连续性、持续学习、护理人员支持和临终关怀）进行的演绎分析。这使我们能够考虑该计划各个组成部分以及整个计划的益处和障碍。
对 GSFCH 的益处包括：改善症状控制和团队沟通；获得有益的外部支持和专业知识；提高员工信心；促进居民的选择；提升养老院的声誉。感知到的障碍包括：增加文书工作；缺乏对临终关怀的知识和理解；成本；以及获得全科医生的合作。GSFCH 的许多工具和任务都集中在改善沟通上。参与者描述了养老院内部以及与全科医生和姑息治疗专家等外部提供者之间的有效沟通。然而，许多人在与全科医生沟通方面遇到了问题。尽管工作人员描述了支持性护理登记册的好处，包括对编码预测疾病阶段和预先护理计划的改进，但有些人认为需要更多的使用经验，并且对讨论死亡感到担忧。
参与者描述的大多数障碍与其他改善养老院临终关怀的干预措施相关。需要研究质量改进计划在养老院中的影响，例如 GSFCH，以了解对居民及其家属更广泛的结果，并监测任何由此产生的改进的可持续性。探索这些复杂干预措施的不同组成部分的影响也很重要。
