Department of Family and Community Medicine, University of Missouri, Columbia, MO.
Schools of Medicine and Nursing, University of Washington, Seattle, WA.
J Am Med Dir Assoc. 2018 Feb;19(2):136-140. doi: 10.1016/j.jamda.2017.08.012. Epub 2017 Sep 30.
Older adults in need of residential services are increasingly spending their final days in small, domestic-style care settings such as adult family homes. In this study, we sought to identify processes that facilitated the provision of quality hospice care to seriously ill residents of adult family homes and their family members.
We conducted a secondary analysis of qualitative data collected as part of a randomized clinical trial of a problem-solving intervention for family members of hospice patients.
The original trial was conducted in partnership with 2 large, community-based hospice agencies in the state of Washington.
Data from 73 family members of residents of adult family homes receiving hospice services were included in the analysis.
Data were collected via semi-structured individual interviews, which were audio-recorded and transcribed prior to analysis.
Family members described quality hospice care in the adult family home as care that is consistent with residents and families' values and that results in comfort and social connectedness for residents while promoting peace of mind and decreasing burden for residents' families. They identified numerous processes that facilitated the provision of quality care including personalizing care, sharing information and expertise, working together to resolve conflicts, and prioritizing residents and families' values over existing or competing philosophies of care.
The adult family home setting can amplify both the benefits and challenges associated with receipt of hospice. When choosing an adult family home, older adults and their families should strongly consider selecting a home with a track record of positive collaborations with hospice agencies if the need for end-of-life care is anticipated.
需要居住服务的老年人越来越多地在小型家庭式护理环境中度过他们的最后日子，例如成人家庭之家。在这项研究中，我们试图确定促进为成人家庭之家的重病居民及其家庭成员提供优质临终关怀服务的过程。
我们对作为对临终患者家属的问题解决干预措施的随机临床试验的一部分收集的定性数据进行了二次分析。
原始试验是与华盛顿州的 2 个大型基于社区的临终关怀机构合作进行的。
接受临终关怀服务的成人家庭之家居民的 73 名家属的数据包括在分析中。
数据通过半结构化的个人访谈收集，在分析之前进行了音频记录和转录。
家属将成人家庭之家的优质临终关怀描述为符合居民和家庭价值观的护理，为居民提供舒适和社交联系，同时为居民的家人提供安心并减轻负担。他们确定了许多促进优质护理的过程，包括个性化护理、分享信息和专业知识、共同努力解决冲突，以及优先考虑居民和家庭的价值观而不是现有的或竞争的护理理念。
成人家庭之家的环境可以放大接受临终关怀的相关益处和挑战。如果预计需要临终关怀，老年人及其家属在选择成人家庭之家时，应强烈考虑选择与临终关怀机构有积极合作记录的家庭。
