Thomsen Kia Toft, Guldin Mai-Britt, Nielsen Mette Kjærgaard, Ollars Chaitali Laura, Jensen Anders Bonde
Department of Oncology, Aarhus University Hospital, Noerrebrogade 44, Aarhus C, 8000, Denmark.
Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus C, 8000, Denmark.
BMC Palliat Care. 2017 Apr 8;16(1):23. doi: 10.1186/s12904-017-0196-x.
Caregiving is strenuous and it may be associated with adverse psychological outcomes. During the palliative care trajectory, there are unique opportunities for providing support and preventing poor bereavement outcome. However, the tasks of palliative care staff in relation to caregivers are often unclear in the daily practice. Assessment is recommended to establish risk and needs and standards for caregiver support are available. Still, the feasibility of applying these standards among caregivers in everyday clinical practice has not been tested so far.
This study tested the feasibility of an intervention based on key elements of the "Bereavement support standards for specialist palliative care services" in a Danish specialised palliative home care team. We followed the UK Medical Research Council's guidelines for the process evaluation of complex interventions. The intervention consisted of: 1. Systematic risk and needs assessment for caregivers at care entry; 2. Interdisciplinary conference to prepare a support plan; 3. Targeted support; 4. The establishment of an electronic medical record for caregivers to document targeted support. Outcomes included the reach, fidelity and acceptability of the intervention as well as the assessment of contextual factors.
The intervention reached 76 of 164 caregivers (46%). The interdisciplinary risk assessment and documentation of a support plan was conducted in 57 (75%) of the enrolled caregivers. Finally, a separate medical record was established according to the intervention blueprint for 62% of caregivers receiving targeted support. After managing initial challenges, palliative care staff reported that the intervention was useful and acceptable.
The intervention proved feasible and useful. Still, we identified barriers to the implementation which should be taken into consideration when planning implementation of a systematic risk and needs assessment and in the establishment of medical records for caregivers.
照护工作十分繁重，可能会带来不良心理后果。在姑息治疗过程中，存在提供支持和预防不良丧亲结局的独特机会。然而，在日常实践中，姑息治疗工作人员与照护者相关的任务往往不明确。建议进行评估以确定风险和需求，并且有照护者支持的标准。尽管如此，到目前为止，在日常临床实践中对照护者应用这些标准的可行性尚未得到检验。
本研究在丹麦一家专门的姑息家庭护理团队中，测试了基于“专科姑息治疗服务丧亲支持标准”关键要素的干预措施的可行性。我们遵循了英国医学研究委员会关于复杂干预措施过程评估的指南。该干预措施包括：1. 在照护开始时对照护者进行系统的风险和需求评估；2. 召开跨学科会议以制定支持计划；3. 有针对性的支持；4. 为照护者建立电子病历以记录有针对性的支持。结果包括干预措施的覆盖面、保真度和可接受性以及对背景因素的评估。
该干预措施覆盖了164名照护者中的76名（46%）。在57名（75%）登记的照护者中进行了跨学科风险评估并记录了支持计划。最后，根据干预蓝图为接受有针对性支持的62%的照护者建立了单独的病历。在应对了最初的挑战后，姑息治疗工作人员报告称该干预措施是有用且可接受的。
该干预措施被证明是可行且有用的。尽管如此，我们确定了实施过程中的障碍，在规划系统的风险和需求评估的实施以及为照护者建立病历的过程中应予以考虑。
