Department of Consumer Science, Purdue University, West Lafayette, Indiana.
Division of Nephrology, Department of Medicine, University of Rochester, Rochester, New York.
J Pain Symptom Manage. 2018 Aug;56(2):239-244. doi: 10.1016/j.jpainsymman.2018.04.013. Epub 2018 May 2.
Maximizing value in palliative care requires continued development and standardization of communication quality indicators.
To describe the basic epidemiology of a newly adopted patient-centered communication quality indicator for hospitalized palliative care patients with advanced cancer.
Cross-sectional analysis of 207 advanced cancer patients who received palliative care consultation at two medical centers in the U.S. Participants completed the Heard & Understood quality indicator immediately before and the day after the initial palliative care consultation: Over the past two days ["24 hours" for the post-consultation version], how much have you felt heard and understood by the doctors, nurses, and hospital staff?-completely/quite a bit/moderately/slightly/not at all. We categorized completely as indicating ideal quality.
Approximately one-third indicated ideal Heard & Understood quality before palliative care consultation. Age, financial security, emotional distress, preferences for comfort-longevity tradeoffs at the end of life, and prognosis expectations were associated with preconsultation quality. Among those with less-than-ideal quality at baseline, 56% rated feeling more Heard & Understood the day after palliative care consultation. The greatest prepost improvement was among people who had unformed end-of-life treatment preferences or who reported having no idea about their prognosis at baseline.
Most patients felt incompletely heard and understood at the time of referral to palliative care consultation, and more than half of the patients improved after consultation. Feeling heard and understood is an important quality indicator sensitive to interventions to improve care and key variations in the patient experience.
在姑息治疗中实现价值最大化需要持续开发和标准化沟通质量指标。
描述新采用的以患者为中心的姑息治疗住院患者的沟通质量指标的基本流行病学，这些患者患有晚期癌症。
对在美国两家医疗中心接受姑息治疗咨询的 207 名晚期癌症患者进行横断面分析。参与者在接受姑息治疗咨询前后立即完成 Heard & Understood 质量指标：在过去两天中，[咨询后版本为“24 小时”]，医生、护士和医院工作人员对你的倾听和理解程度如何？完全/相当多/中等/有点/一点也不。我们将完全表示理想的质量。
大约三分之一的人在接受姑息治疗咨询前表示理想的 Heard & Understood 质量。年龄、财务保障、情绪困扰、对生命末期舒适与长寿权衡的偏好以及预后预期与咨询前的质量相关。在基线时质量较差的患者中，有 56%的人在接受姑息治疗咨询后感觉自己的倾听和理解程度有所提高。在那些基线时没有形成临终治疗偏好或不知道自己预后的人中，改善最大。
大多数患者在转诊至姑息治疗咨询时感觉自己没有被完全倾听和理解，超过一半的患者在咨询后感觉有所改善。被倾听和理解是一个重要的质量指标，对改善护理和患者体验的关键差异敏感。
