Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, United Kingdom.
King's College Hospital NHS Foundation Trust, London, United Kingdom.
PLoS One. 2018 Jul 11;13(7):e0200240. doi: 10.1371/journal.pone.0200240. eCollection 2018.
Assessment of people with dementia is challenging; with undetected and under treated symptoms and concerns resulting in avoidable distress, and few evidence-based interventions to support this. We aimed to understand the mechanisms of action of a measure to support comprehensive assessment of people with dementia in care homes; and its acceptability, feasibility, and implementation requirements.
A qualitative study with an embedded quantitative component in three residential care homes, underpinned by an initial theoretical model of mechanisms of action. The measure, the Integrated Palliative care Outcome Scale for Dementia (IPOS-Dem), was introduced into the care of residents with dementia for 12 weeks. Qualitative data comprised focus groups and semi-structured interviews with family, care home staff, general practitioners and district nurses; and non-participant observations. Quantitative data comprised IPOS-Dem data. Directed content analysis for qualitative data, and descriptive statistics were used for quantitative data.
Key mechanisms of action were: improved observation and awareness of residents, collaborative assessment, comprehensive 'picture of the person', systematic record keeping, improved review and monitoring, care planning and changes to care provision, and facilitated multi-agency communication. Potential benefit included improved symptom management, improved comprehensive care, and increased family empowerment and engagement. IPOS-Dem was found to be acceptable and feasible. It was perceived as quick and easy to use, with proportion of overall missing data decreasing from 2.1% to 1.1% from baseline to final time points. 'Trust' in the measure was important; and leadership essential to ensure integration into care processes.
In a population with complex care needs, with challenges to assessment and barriers to multi-agency working, a measure introduced into routine care is feasible and acceptable, and supports assessment and management of symptoms and concerns. A refined theoretical model demonstrating the likely mechanisms of action was developed. Further evaluation is required to test its effectiveness.
对痴呆症患者的评估具有挑战性；由于未被发现和治疗的症状和问题，导致了本可避免的痛苦，且缺乏支持这种评估的循证干预措施。我们旨在了解一种支持对养老院中痴呆症患者进行全面评估的措施的作用机制；以及其可接受性、可行性和实施要求。
在三家养老院中进行了一项定性研究，其中嵌入了一个初步的作用机制理论模型。该措施是综合姑息治疗痴呆症结局量表（IPOS-Dem），在 12 周内引入到患有痴呆症的居民护理中。定性数据包括对家庭、养老院工作人员、全科医生和地区护士的焦点小组和半结构化访谈；以及非参与观察。定量数据包括 IPOS-Dem 数据。对定性数据进行定向内容分析，对定量数据进行描述性统计。
主要作用机制包括：提高对居民的观察和意识，协作评估，全面的“个人画像”，系统的记录保存，改进审查和监测，护理计划和护理提供的改变，以及促进多机构沟通。潜在的好处包括改善症状管理，改善全面护理，以及增强家庭授权和参与。IPOS-Dem 被认为是可接受和可行的。它被认为使用起来既快速又简单，从基线到最终时间点，总缺失数据的比例从 2.1%下降到 1.1%。对该措施的“信任”很重要；领导层对于确保其纳入护理过程至关重要。
在一个具有复杂护理需求的人群中，评估面临挑战，多机构合作存在障碍，在常规护理中引入一种措施是可行和可接受的，并支持症状和问题的评估和管理。开发了一个展示可能作用机制的精炼理论模型。需要进一步评估来测试其有效性。
