Florence Nightingale Foundation Professor of Clinical Nursing Practice Research, School of Medicine, Dentistry and Nursing, University of Glasgow, 57-61 Oakfield Avenue, Room 61/504, Glasgow, G12 8LL, UK.
School of Sociology and Social Policy, University Park, University of Nottingham, Nottingham, NG7 2RD, UK.
BMC Palliat Care. 2018 Feb 23;17(1):36. doi: 10.1186/s12904-018-0281-9.
The Midhurst Macmillan Specialist Palliative Care at Home Service was founded in 2006 to improve community-based palliative care provision. Principal components include; early referral; home-based clinical interventions; close partnership working; and flexible teamwork. Following a successful introduction, the model was implemented in six further sites across England. This article reports a mixed methods evaluation of the implementation across these 'Innovation Centres'. The evaluation aimed to assess the process and impact on staff, patients and carers of providing Macmillan Specialist Care at Home services across the six sites.
The study was set within a Realist Evaluation framework and used a longitudinal, mixed methods research design. Data collection over 15 months (2014-2016) included: Quantitative outcome measures - Palliative Performance Scale [PPS] and Palliative Prognostic Index [PPI] (n = 2711); Integrated Palliative Outcome Scales [IPOS] (n = 1157); Carers Support Needs Assessment Tool [CSNAT] (n = 241); Views of Informal Carers -Evaluation of Services [VOICES-SF] (n = 102); a custom-designed Service Data Tool [SDT] that gathered prospective data from each site (n = 88). Qualitative data methods included: focus groups with project team and staff (n = 32 groups with n = 190 participants), and, volunteers (n = 6 groups with n = 32 participants). Quantitative data were analysed using SPPS Vs. 21 and qualitative data was examined via thematic analysis.
Comparison of findings across the six sites revealed the impact of their unique configurations on outcomes, compounded by variations in stage and mode of implementation. PPS, PPI and IPOS data revealed disparity in early referral criteria, complicated by contrasting interpretations of palliative care. The qualitative analysis, CSNAT and VOICES-SF data confirmed the value of the Macmillan model of care but uptake of specialist home-based clinical interventions was limited. The Macmillan brand engendered patient and carer confidence, bringing added value to existing services. Significant findings included better co-ordination of palliative care through project management and a single referral point and multi-disciplinary teamwork including leadership from consultants in palliative medicine, the role of health care assistants in rapid referral, and volunteer support.
Macmillan Specialist Care at Home increases patient choice about place of death and enhances the quality of end of life experience. Clarification of key components is advocated to aid consistency of implementation across different sites and support future evaluative work.
米尔赫斯特麦克米伦临终关怀居家服务于 2006 年成立，旨在改善社区为基础的临终关怀服务。主要内容包括：早期转介；居家临床干预；密切的合作工作；灵活的团队合作。在成功推出后，该模式在英格兰的另外六个地点实施。本文报告了对这些“创新中心”实施情况的混合方法评估。该评估旨在评估在六个地点提供麦克米伦临终关怀居家服务对员工、患者和护理人员的过程和影响。
该研究是在现实主义评估框架内进行的，采用了纵向、混合方法的研究设计。在 15 个月（2014-2016 年）期间进行了数据收集：定量结果测量 - 临终表现量表[PPS]和临终预后指数[PPI]（n=2711）；综合临终结局量表[IPOS]（n=1157）；护理人员支持需求评估工具[CSNAT]（n=241）；非正规护理人员意见评估服务[VOICES-SF]（n=102）；定制的服务数据工具[SDT]，从每个站点收集前瞻性数据（n=88）。定性数据方法包括：与项目团队和工作人员进行焦点小组讨论（n=32 组，n=190 名参与者），以及志愿者（n=6 组，n=32 名参与者）。使用 SPPS Vs. 21 对定量数据进行分析，使用主题分析对定性数据进行分析。
对六个站点的调查结果进行比较发现，其独特配置对结果产生了影响，而实施的阶段和模式的差异则使情况更加复杂。PPS、PPI 和 IPOS 数据显示早期转介标准存在差异，对姑息治疗的解释也存在差异。定性分析、CSNAT 和 VOICES-SF 数据证实了麦克米伦护理模式的价值，但对专科居家临床干预的接受程度有限。麦克米伦品牌增强了患者和护理人员的信心，为现有服务带来了附加值。重要的发现包括通过项目管理和单一转介点以及多学科团队合作更好地协调姑息治疗，包括姑息医学顾问的领导作用、医疗助理在快速转介中的作用，以及志愿者的支持。
麦克米伦临终关怀居家服务增加了患者对死亡地点的选择，并提高了临终体验的质量。提倡澄清关键组成部分，以帮助不同地点的实施保持一致，并支持未来的评估工作。
