Kallianis Voula, Joubert Lynette, Gorman Sue, Posenelli Sonia, Lethborg Carolyn
a Social Work , St Vincent's Hospital , Melbourne , Kew , Australia.
b Social Work , University of Melbourne , Parkville, Melbourne , Australia.
J Soc Work End Life Palliat Care. 2017 Apr-Sep;13(2-3):193-204. doi: 10.1080/15524256.2017.1331180. Epub 2017 Jun 1.
The survival of patients with advanced cancer, coupled with the increased presence of end-stage chronic illnesses in an aging population, is leading to a demand in palliative care. Due to the ongoing need for acute-pain and symptom control in hospice/palliative care units, few are able to offer long-stay admission for those whose symptoms have stabilized. When a patient no longer requires specialist palliative care services, transfer from an inpatient palliative care facility may then be necessary. A core component of the role of palliative-care social workers involves working with patients and their families/carers when the care pathway shifts and the option of residential aged care facility (RACF) needs to be considered. This research explored several issues, including the impact of this transition on the patient and their families and on the interdisciplinary health care team treating the patient. An investigation was undertaken to identify concerns and barriers regarding the transition from hospice care to RACF and opportunities were highlighted to improve clinical practice in this area. A tripartite approach was adopted conducting face-to-face interviews with patients, their families/carers, and health care professionals. Members of the interdisciplinary team were interviewed and social workers working in similar inpatient palliative-care facilities undertook telephone interviews to gauge their experiences. A thematic analysis discerned a number of themes highlighting the impact of this transition on key stakeholders and incorporated recommendations to improve or best manage this process. The research has highlighted the difficulties that patients/families encounter in this transition, as well as the emphases of protecting the integrity of the patient and family. This is achieved by holding open and ongoing dialogue, particularly through family meetings and working in collaboration with the patient, the family, and the team. Understanding the experience and impact of this transition on key stakeholders is helpful in building up a knowledge base and to ensure a more effective relationship occurs. This research incorporated the voices of terminally ill patients, families, and members of the health care team in order to understand their views and recommendations for best managing the transition from a hospice/inpatient palliative-care facility to a RACF. This enables their input to have some real impetus in clinical practice and service delivery.
晚期癌症患者的存活，再加上老龄人口中终末期慢性病患者的增多，导致了对姑息治疗的需求。由于临终关怀/姑息治疗病房持续需要进行急性疼痛和症状控制，很少有机构能够为症状已稳定的患者提供长期住院服务。当患者不再需要专科姑息治疗服务时，可能就需要从住院姑息治疗机构转出。姑息治疗社会工作者角色的一个核心组成部分，是在护理路径发生转变且需要考虑入住老年护理机构（RACF）这一选择时，与患者及其家人/护理人员合作。本研究探讨了几个问题，包括这种转变对患者及其家人以及对治疗该患者的跨学科医疗团队的影响。开展了一项调查，以确定从临终关怀护理过渡到老年护理机构的相关问题和障碍，并强调了改善该领域临床实践的机会。采用了三方方法，对患者、其家人/护理人员以及医疗专业人员进行面对面访谈。对跨学科团队成员进行了访谈，并且在类似住院姑息治疗机构工作的社会工作者进行了电话访谈，以了解他们的经验。主题分析识别出了一些主题，突出了这种转变对关键利益相关者的影响，并纳入了改善或最佳管理这一过程的建议。该研究突出了患者/家人在这种转变中遇到的困难，以及保护患者和家庭完整性的重点。这是通过进行开放且持续的对话来实现的，特别是通过家庭会议以及与患者、家庭和团队合作。了解这种转变对关键利益相关者的经历和影响，有助于建立知识库并确保建立更有效的关系。本研究纳入了绝症患者、家人以及医疗团队成员的意见，以便了解他们对于最佳管理从临终关怀/住院姑息治疗机构过渡到老年护理机构的看法和建议。这使得他们的意见能够在临床实践和服务提供中产生一些实际推动作用。
