Williams Beverly Rosa, Bailey F Amos, Noh Hyunjin, Woodby Lesa L, Wittich Angelina R, Burgio Kathryn L
a Department of Veterans Affairs , Geriatric Research, Education and Clinical Center , Birmingham , Alabama , USA.
J Soc Work End Life Palliat Care. 2015;11(1):50-73. doi: 10.1080/15524256.2015.1021070.
This study explored next-of-kin's retrospective accounts of hospice and palliative care discussions for hospitalized veterans. In-depth, face-to-face interviews were used to generate narrative accounts of 78 next-of-kin's experience of their loved one's hospital care during the last days of the patient's life. One-third of participants reported taking part in a hospice or palliative care discussion during the patient's final hospitalization. In over one-half of those cases, the patients died before discharge or transfer to hospice or palliative care was accomplished. Hospice and palliative care discussions in the hospital setting shaped family perceptions of the patients' care, directed family efforts in the days prior to death, and engendered anticipation of remaining quality time with the patient. Discussions about hospice or palliative care have meaning, emotional impact, practical effects, and unintended consequences for next-of-kin. Social workers in hospital settings can play a critical role in supporting family members through the hospice and palliative care discussion process and facilitate timely care transitions. They also can attend to the psychosocial concerns of family members, particularly when death occurs prior to discharge to hospice or transfer to an inpatient palliative care service.
本研究探讨了亲属对住院退伍军人临终关怀和姑息治疗讨论的回顾性叙述。通过深入的面对面访谈，收集了78位亲属对其亲人在患者生命最后阶段住院护理经历的叙述。三分之一的参与者报告称在患者最后一次住院期间参与了临终关怀或姑息治疗讨论。在超过一半的此类案例中，患者在出院前死亡，或在转至临终关怀或姑息治疗机构之前就已离世。医院环境中的临终关怀和姑息治疗讨论塑造了家属对患者护理的认知，指导了家属在患者去世前几天的努力，并引发了与患者共度剩余美好时光的期待。关于临终关怀或姑息治疗的讨论对亲属具有意义、情感影响、实际效果和意外后果。医院环境中的社会工作者在支持家属度过临终关怀和姑息治疗讨论过程以及促进及时的护理过渡方面可以发挥关键作用。他们还可以关注家属的心理社会问题，尤其是在患者在转至临终关怀机构或转入住院姑息治疗服务之前死亡的情况下。
