School of Nursing, University of British Columbia, Okanagan, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada.
Greater Trail Hospice Society, 1500 Columbia Ave, Suite 7, Rossland, BC, V1R 1J9, Canada.
BMC Palliat Care. 2017 Jun 5;16(1):37. doi: 10.1186/s12904-017-0211-2.
Few services are available to support rural older adults living at home with advancing chronic illness. The objective of this project was to pilot a nurse-led navigation service to provide early palliative support for rural older adults and their families living at home with advancing chronic illness.
Twenty-five older adults and 11 family members living with advancing chronic illness received bi-weekly home visits by a nurse navigator over a 2-year period. Navigation services included symptom management, education, advance care planning, advocacy, mobilization of resources, and psychosocial support. The nurse navigator collected longitudinal data on older adult and family needs, and older adult quality of life and healthcare utilization.
Satisfaction with the service was high. There was no attrition over the 2-year period except through death, and few cancelled visits, indicating a high degree of acceptability of the intervention. The navigator addressed complex, multi-faceted needs through connecting health, social, and informal community resources. Participants who indicated a preferred place of death were able to die in that preferred place (n = 7). Emergency room use by participants was minimal and largely unpreventable by the nurse navigator. Longitudinal health-related quality of life scores for many participants were poor, lending further support to the need for more focused attention to this upstream palliative population.
Using a nurse navigator to facilitate early palliative care for rural older adults living with advanced chronic illness is a promising innovation for meeting the needs of this population. Further research is required to evaluate outcomes on a larger scale.
为了支持在家中患有慢性疾病的农村老年人，很少有服务可用。本项目的目的是试点护士主导的导航服务，为在家中患有慢性疾病的农村老年人及其家属提供早期姑息治疗。
在 2 年期间，25 名患有慢性疾病的老年人和 11 名家属接受了护士导航员每两周一次的家访。导航服务包括症状管理、教育、预先护理计划、倡导、资源调动和心理社会支持。护士导航员收集了老年人及其家属需求的纵向数据，以及老年人的生活质量和医疗保健利用情况。
对该服务的满意度很高。在 2 年期间没有出现人员流失，除了死亡之外，很少有人取消预约，这表明该干预措施的接受度很高。导航员通过连接健康、社会和非正式社区资源来满足复杂的、多方面的需求。表示有首选死亡地点的参与者能够在该地点去世（n=7）。参与者的急诊室使用量很少，而且护士导航员很难预防。许多参与者的健康相关生活质量评分长期较差，进一步支持了更集中关注这一上游姑息治疗人群的必要性。
为在家中患有晚期慢性疾病的农村老年人提供护士主导的姑息治疗是满足这一人群需求的有前途的创新。需要进一步的研究来评估更大规模的结果。
