Wilkinson Emma, Randhawa Gurch, Brown Edwina, Da Silva Gane Maria, Stoves John, Warwick Graham, Mir Tahira, Magee Regina, Sharman Sue, Farrington Ken
Institute for Health Research, University of Bedfordshire, Luton, UK.
Imperial College Healthcare NHS Trust, London, UK.
Clin Kidney J. 2017 Jun;10(3):419-424. doi: 10.1093/ckj/sfw151. Epub 2017 Feb 16.
With an ageing and increasingly diverse population at risk from rising levels of obesity, diabetes and cardiovascular disease, including kidney complications, there is a need to provide quality care at all stages in the care pathway including at the end of life and to all patients. . This study purposively explored South Asian patients' experiences of kidney end of life care to understand how services can be delivered in a way that meets diverse patient needs. Within an action research design 14 focus groups (45 care providers) of kidney care providers discussed the recruitment and analysis of individual interviews with 16 South Asian kidney patients (eight men, eight women). Emergent themes from the focus groups were analysed thematically. The research took place at four UK centres providing kidney care to diverse populations: West London, Luton, Leicester and Bradford. Key themes related to time and the timing of discussions about end of life care and the factors that place limitations on patients and providers in talking about end of life care. Lack of time and confidence of nurses in areas of kidney care, individual attitudes and workforce composition influence whether and how patients have access to end of life care through kidney services. Training, team work and time to discuss overarching issues (including timing and communication about end of life) with colleagues could support service providers to facilitate access and delivery of end of life care to this group of patients.
随着人口老龄化以及肥胖、糖尿病和心血管疾病（包括肾脏并发症）风险不断增加，人口日益多样化，有必要在护理路径的各个阶段，包括生命末期，为所有患者提供优质护理。本研究有目的地探索了南亚患者在肾脏疾病终末期护理方面的经历，以了解如何以满足不同患者需求的方式提供服务。在行动研究设计中，14个肾脏护理提供者焦点小组（45名护理提供者）讨论了对16名南亚肾脏患者（8名男性，8名女性）进行个人访谈的招募和分析。对焦点小组中出现的主题进行了主题分析。该研究在英国四个为不同人群提供肾脏护理的中心进行：西伦敦、卢顿、莱斯特和布拉德福德。关键主题涉及与终末期护理讨论的时间和时机，以及在谈论终末期护理时对患者和提供者造成限制的因素。护士在肾脏护理领域缺乏时间和信心、个人态度以及劳动力构成，会影响患者能否以及如何通过肾脏服务获得终末期护理。培训、团队合作以及与同事讨论总体问题（包括终末期护理的时机和沟通）的时间，可以支持服务提供者为这组患者提供并促进终末期护理。
