“他们需要了解自己为什么来这里，以及可能会有什么结果。”临床医生对从医院转至疗养院的患者的照护目标的看法。
"They Need to Have an Understanding of Why They're Coming Here and What the Outcomes Might Be." Clinician Perspectives on Goals of Care for Patients Discharged From Hospitals to Skilled Nursing Facilities.
机构信息
Yale School of Nursing, West Haven, Connecticut, USA.
Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
出版信息
J Pain Symptom Manage. 2018 Mar;55(3):930-937. doi: 10.1016/j.jpainsymman.2017.10.013. Epub 2017 Oct 31.
CONTEXT
The number of patients discharged from acute care hospitals to skilled nursing facilities (SNFs) is rising. These patients have increasingly complex needs and many experience poor outcomes while under SNF care, including hospital readmissions. Patients' goals of care (GoC) are viewed as a factor contributing to unplanned hospital readmissions from SNFs. However, clinicians' perspectives of GoC for hospitalized patients discharged to SNFs are not well-described.
OBJECTIVES
To explore how clinicians view GoC for hospitalized patients discharged to SNFs.
METHODS
Qualitative study using semi-structured interviews and thematic analysis.
RESULTS
Forty-one clinicians from one acute care hospital and two SNFs completed interviews ranging in length from 14 to 52 minutes (mean = 32 minutes). Of the sample, 22% were nurses, 20% physicians, 15% were from care management, and 15% were from social services. Respondents viewed patients' GoC for continuing treatment at the SNF as important, but acknowledged that they were infrequently discussed during hospitalization. Many respondents felt that patients and families had unrealistic GoC for SNF care. Factors that contributed to unrealistic GoC included patients' limited knowledge of disease processes, prognosis, and treatment options; and inconsistent or insufficient communication of GoC among hospital and SNF clinicians, the patient, and family members. Respondents associated a lack of GoC or unrealistic GoC with patients' dissatisfaction with SNF care, unplanned transitions to hospice, and hospital readmissions.
CONCLUSIONS
Respondents reported that GoC conversations infrequently occurred during hospitalization, contributing to unrealistic patient and family expectations for SNF care and poor patient outcomes. Interventions are needed that facilitate timely, accurate, and consistent GoC discussions across care continuums.
背景
从急性护理医院出院到熟练护理设施（SNF）的患者人数正在增加。这些患者的需求越来越复杂，许多人在 SNF 护理下的结果不佳，包括再次住院。患者的治疗目标（GoC）被视为导致 SNF 无计划再次住院的一个因素。然而，临床医生对出院到 SNF 的住院患者的 GoC 看法尚未得到很好的描述。
目的
探讨临床医生如何看待出院到 SNF 的住院患者的 GoC。
方法
采用半结构式访谈和主题分析的定性研究。
结果
一家急性护理医院和两家 SNF 的 41 名临床医生完成了访谈，访谈时间从 14 分钟到 52 分钟不等（平均 32 分钟）。在样本中，22%是护士，20%是医生，15%来自护理管理部门，15%来自社会服务部门。受访者认为患者在 SNF 继续治疗的 GoC 很重要，但承认在住院期间很少讨论。许多受访者认为患者和家属对 SNF 护理的 GoC 不切实际。导致不切实际的 GoC 的因素包括患者对疾病过程、预后和治疗方案的了解有限；以及医院和 SNF 临床医生、患者和家属之间对 GoC 的沟通不一致或不足。受访者将缺乏 GoC 或不切实际的 GoC 与患者对 SNF 护理的不满、无计划过渡到临终关怀以及再次住院联系起来。
结论
受访者报告说，在住院期间很少进行 GoC 对话，导致患者和家属对 SNF 护理的期望不切实际，患者结局不佳。需要采取干预措施，促进跨护理连续体的及时、准确和一致的 GoC 讨论。
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