Ciemins Elizabeth L, Brant Jeannine, Kersten Diane, Mullette Elizabeth, Dickerson Dustin
1 Center for Clinical Translational Research, Billings Clinic , Billings, Montana.
J Palliat Med. 2015 Mar;18(3):282-5. doi: 10.1089/jpm.2014.0155. Epub 2014 Oct 9.
To provide truly patient-centered palliative care services, there is a need to better understand the perspectives and experiences of patients and families. Increased understanding will provide insight into the development of health care team competencies and organizational changes necessary to improve patient care.
Our aim was to explore patient and family perceptions of palliative care services at the end of life or during serious illness and to identify facilitators and barriers to receipt of palliative care services.
In-depth, semi-structured patient and family interviews were conducted, transcribed, and independently reviewed using grounded theory methodology and preliminary interpretations. A combined deductive and inductive iterative qualitative approach was used to identify recurring themes. The study was conducted in a physician-led, not-for-profit, multispecialty integrated health system serving three large, western, rural states. A purposive sample of 14 individuals who received palliative care services were interviewed alone or with their families for a total of 12 interviews.
Presence, Reassurance, and Honoring Choices emerged as central themes linked to satisfaction with palliative care services. Themes were defined as including health care professional attributes of respect, approachability, genuineness, empathy, connectedness, compassion, sensitivity, an ability to listen, good communication, provision of information, empowerment, and timeliness. Honoring Choices included those pertaining to treatment, spirituality, and family needs.
At end of life or during times of serious illness, patients and families identified behaviors of Presence, Reassurance, and Honoring Choices as important. According to patients/families, health care providers must be compassionate and empathetic and possess skills in listening, connecting, and interacting with patients and families.
为了提供真正以患者为中心的姑息治疗服务，有必要更好地了解患者及其家属的观点和经历。增进了解将有助于洞察为改善患者护理所需的医疗团队能力发展和组织变革。
我们的目标是探讨患者及其家属在生命末期或重病期间对姑息治疗服务的看法，并确定接受姑息治疗服务的促进因素和障碍。
采用扎根理论方法和初步解释，对患者及其家属进行了深入的半结构化访谈，进行了转录并独立审查。采用演绎和归纳相结合的迭代定性方法来确定反复出现的主题。该研究在一个由医生主导、非营利性、多专科综合医疗系统中进行，该系统服务于西部三个大型农村州。对14名接受姑息治疗服务的个体进行了有目的抽样，他们单独或与家人接受了访谈，共进行了12次访谈。
“陪伴、安心和尊重选择”成为与对姑息治疗服务满意度相关的核心主题。这些主题被定义为包括医疗保健专业人员的尊重、平易近人、真诚同理心、联系感、同情心、敏感性、倾听能力、良好沟通、信息提供、赋权和及时性等属性。尊重选择包括与治疗、灵性和家庭需求相关的那些方面。
在生命末期或重病期间，患者及其家属认为陪伴、安心和尊重选择的行为很重要据患者/家属称，医疗保健提供者必须富有同情心和同理心，并具备倾听、与患者及其家属建立联系和互动的技能。
