Sandsdalen Tuva, Grøndahl Vigdis Abrahamsen, Hov Reidun, Høye Sevald, Rystedt Ingrid, Wilde-Larsson Bodil
Department of Health Studies, Faculty of Public Health, Hedmark University of Applied Sciences, Postbox 400, 2418, Elverum, Norway.
Department of Health Science, Faculty of Health, Science and Technology, Discipline of Nursing Science, Karlstad University, 651 88, Karlstad, Sweden.
BMC Palliat Care. 2016 Aug 24;15(1):79. doi: 10.1186/s12904-016-0152-1.
Patients' perceptions of care quality within and across settings are important for the further development of palliative care. The aim was to investigate patients' perceptions of palliative care quality within settings, including perceptions of care received and their subjective importance, and contrast palliative care quality across settings.
A cross-sectional study including 191 patients in late palliative phase (73 % response rate) admitted to hospice inpatient care, hospice day care, palliative units in nursing homes, and home care was conducted, using the Quality from the Patients' Perspective instrument-palliative care (QPP-PC). QPP-PC comprises four dimensions and 12 factors; "medical-technical competence" (MT) (2 factors), "physical-technical conditions" (PT) (one factor), "identity-orientation approach" (ID) (4 factors), "sociocultural atmosphere" (SC) (5 factors), and three single items (S); medical care, personal hygiene and atmosphere. Data were analysed using paired-samples t-test and analysis of covariance while controlling for differences in patient characteristics.
Patients' perceptions of care received within settings showed high scores for the factors and single items "honesty" (ID) and "atmosphere" (S) in all settings and low scores for "exhaustion" (MT) in three out of four settings. Patients' perceptions of importance scored high for "medical care" (S), "honesty" (ID), "respect and empathy" (ID) and "atmosphere" (S) in all settings. No aspects of care scored low in all settings. Importance scored higher than perceptions of care received, in particular for receiving information. Patients' perceptions of care across settings differed, with highest scores in hospice inpatient care for the dimensions; ID, SC, and "medical care" (S), the SC and "atmosphere" (S) for hospice day care, and "medical care" (S) for palliative units in nursing homes. There were no differences in subjective importance across settings.
Strengths of services related to identity-orientation approach and a pleasant and safe atmosphere. Key areas for improvement related to receiving information. Perceptions of subjective importance did not differ across settings, but perceptions of care received scored higher in more care areas for hospice inpatient care, than in other settings. Further studies are needed to support these findings, to investigate why perceptions of care differ across settings and to highlight what can be learned from settings receiving high scores.
患者对不同环境下护理质量的认知对于姑息治疗的进一步发展至关重要。本研究旨在调查患者对不同环境下姑息治疗质量的认知，包括对所接受护理的认知及其主观重要性，并对比不同环境下的姑息治疗质量。
采用横断面研究，纳入191名处于姑息治疗晚期的患者（应答率73%），这些患者分别入住临终关怀住院护理机构、临终关怀日间护理机构、养老院的姑息治疗单元以及接受家庭护理，研究使用了患者视角下的质量-姑息治疗量表（QPP-PC）。QPP-PC包含四个维度和12个因素；“医疗技术能力”（MT）（2个因素）、“物理技术条件”（PT）（1个因素）、“身份导向方法”（ID）（4个因素）、“社会文化氛围”（SC）（5个因素）以及三个单项（S）；医疗护理、个人卫生和氛围。在控制患者特征差异的同时，使用配对样本t检验和协方差分析对数据进行分析。
患者对不同环境下所接受护理的认知显示，所有环境下“诚实”（ID）因素和单项“氛围”（S）得分较高，而在四个环境中的三个环境下，“疲惫”（MT）得分较低。患者对重要性的认知在所有环境下，“医疗护理”（S）、“诚实”（ID）、“尊重与同理心”（ID）和“氛围”（S）得分较高。没有任何护理方面在所有环境下得分都低。重要性得分高于对所接受护理的认知，尤其是在获取信息方面。患者对不同环境下护理的认知存在差异，在临终关怀住院护理机构中，维度ID、SC和单项“医疗护理”（S）得分最高；在临终关怀日间护理机构中，SC和“氛围”（S）得分最高；在养老院的姑息治疗单元中，“医疗护理”（S）得分最高。不同环境下主观重要性没有差异。
与身份导向方法以及愉悦安全氛围相关的服务优势明显。需要改进的关键领域与获取信息有关。不同环境下主观重要性的认知没有差异，但临终关怀住院护理机构在更多护理领域中对所接受护理的认知得分高于其他环境。需要进一步研究来支持这些发现，调查不同环境下护理认知存在差异的原因，并突出从得分高的环境中可以学到什么。
