Rocky Mountain Regional Veterans Affairs Medical Center, Denver-Seattle Center of Innovation, Aurora, CO, USA.
Department of Health & Behavioral Sciences, University of Colorado Downtown Campus, Denver, CO, USA.
Support Care Cancer. 2019 Apr;27(4):1263-1270. doi: 10.1007/s00520-018-4552-z. Epub 2018 Nov 22.
Veterans with advanced cancer can receive hospice care concurrently with treatments such as radiation and chemotherapy. However, variations exist in concurrent care use across Veterans Affairs (VA) medical centers (VAMCs), and overall, concurrent care use is relatively rare. In this qualitative study, we aimed to identify, describe, and explain factors that influence the provision of concurrent cancer care (defined as chemotherapy or radiation treatments provided with hospice) for veterans with terminal cancer.
From August 2015 to April 2016, we conducted six site visits and interviewed 76 clinicians and staff at six VA sites and their contracted community hospices, including community hospices (n = 16); VA oncology (n = 25); VA palliative care (n = 17); and VA inpatient hospice and palliative care units (n = 18).
Thematic qualitative content analysis found three themes that influenced the provision of concurrent care: (1) clinicians and staff at community hospices and at VAs viewed concurrent care as a viable care option, as it preserved hope and relationships while patient goals are clarified during transitions to hospice; and (2) the presence of dedicated liaisons facilitated care coordination and education about concurrent care; however, (3) clinicians and staff concerns about Medicare guideline compliance hindered use of concurrent care.
While concurrent care is used by a small number of veterans with advanced cancer, VA staff valued having the option available and as a bridge to hospice. Hospice staff felt concurrent care improved care coordination with VAMCs, but use may be tempered due to concerns related to Medicare compliance.
患有晚期癌症的退伍军人可以同时接受临终关怀护理以及放疗和化疗等治疗。然而，退伍军人事务部（VA）医疗中心（VAMC）之间在同时进行的护理使用方面存在差异，总体而言，同时进行的护理使用相对较少。在这项定性研究中，我们旨在确定、描述和解释影响为患有终末期癌症的退伍军人提供同时进行的癌症护理（定义为同时提供临终关怀和化疗或放疗治疗）的因素。
从 2015 年 8 月到 2016 年 4 月，我们在六个 VA 地点进行了六次现场访问，并采访了六个 VA 地点的 76 名临床医生和工作人员及其合同社区临终关怀机构，包括社区临终关怀机构（n=16）；VA 肿瘤学（n=25）；VA 姑息治疗（n=17）；和 VA 住院临终关怀和姑息治疗单位（n=18）。
主题定性内容分析发现了三个影响同时进行护理的因素：（1）社区临终关怀机构和 VA 的临床医生和工作人员认为同时进行护理是一种可行的护理选择，因为它在向临终关怀过渡期间保持了希望和关系，同时明确了患者的目标；（2）专职联络人存在有助于协调护理和教育关于同时进行的护理；但是，（3）临床医生和工作人员对医疗保险指南合规性的担忧阻碍了同时进行的护理的使用。
虽然只有少数患有晚期癌症的退伍军人使用同时进行的护理，但 VA 工作人员重视有此选择，并将其作为通向临终关怀的桥梁。临终关怀工作人员认为同时进行的护理改善了与 VA 医疗中心的护理协调，但由于与医疗保险合规性相关的担忧，使用可能会受到限制。
