Meeker Mary Ann, Waldrop Deborah P, Seo Jin Young
University at Buffalo School of Nursing,Buffalo,New York.
University at Buffalo School of Social Work,Buffalo,New York.
Palliat Support Care. 2015 Oct;13(5):1283-91. doi: 10.1017/S1478951514001138. Epub 2014 Oct 31.
Our purpose was to rigorously examine the nature of family meetings as conducted in an inpatient hospice care unit in order to generate an inductive theoretical model.
In this two-phase project, we first interviewed eight members of the interdisciplinary care team who participated in multiple family meetings each week. Interview questions explored why and how they conducted family meetings. Using an observation template created from these interview data, we subsequently conducted ethnographic observations during family meetings. Using the methods of grounded theory, our findings were synthesized into a theoretical model depicting the structure and process of formal family meetings within this setting.
The core of the family meeting was characterized by cognitive and affective elements aimed at supporting the family and facilitating quality care by clarifying the past, easing the present, and protecting the future. This inductive model was subsequently found to be highly aligned with a sense of coherence, an important influence on coping, and adaptation to the stress of a life-limiting illness.
Provider communication with family members is particularly critical during advanced illness and end-of-life care. The National Consensus Project clinical practice guidelines for quality palliative care list regular family meetings among the recommended practices for excellent communication during end-of-life care, but do not provide specific guidance on how and when to provide such meetings. Our findings provide a theoretical model that can inform the design of a family meeting to address family members' needs for meaningful and contextualized information, validation of their important contributions to care, and preparation for the patient's death.
我们的目的是严格审视在住院临终关怀病房中举行的家庭会议的性质，以生成一个归纳性理论模型。
在这个两阶段项目中，我们首先采访了八名跨学科护理团队成员，他们每周都参与多次家庭会议。访谈问题探讨了他们举行家庭会议的原因和方式。利用从这些访谈数据创建的观察模板，我们随后在家庭会议期间进行了人种学观察。运用扎根理论方法，我们的研究结果被综合成一个理论模型，描绘了这种环境下正式家庭会议的结构和过程。
家庭会议的核心特点是认知和情感元素，旨在通过厘清过去、缓解当下和守护未来来支持家庭并促进优质护理。随后发现这个归纳模型与连贯感高度契合，连贯感对应对和适应生命有限疾病的压力有重要影响。
在晚期疾病和临终护理期间，医护人员与家庭成员的沟通尤为关键。国家质量姑息治疗共识项目临床实践指南将定期家庭会议列为临终护理期间优质沟通的推荐做法，但未就如何以及何时举行此类会议提供具体指导。我们的研究结果提供了一个理论模型，可用于指导家庭会议的设计，以满足家庭成员对有意义和情境化信息的需求，认可他们对护理的重要贡献，并为患者的死亡做好准备。
