Hutchinson Claire, Tieman Jennifer, Devery Kim
Palliative and Supportive Services, Flinders University Faculty of Medicine, School of Health Sciences, Adelaide, South Australia, Australia.
BMJ Open Qual. 2018 Nov 10;7(4):e000286. doi: 10.1136/bmjoq-2017-000286. eCollection 2018.
The study aimed to determine the effectiveness of an action-orientated toolkit in supporting behaviour change in relation to quality end-of-life care in acute hospital settings. The toolkit was developed to complement a programme of online end-of-life care education.
A toolkit was developed from an international review of peer-reviewed literature on end of life. Toolkits were distributed (n=428) to Australian healthcare professionals over a 4-week period. An online survey was sent to all recipients; 65 responses were received (16% response rate, excluding emails returned as undeliverable). Semistructured interviews (n=10) were conducted using purposeful sampling to ensure a range of views were captured. The focus of the evaluation was on investigating (1) users' responses to the toolkit and (2) individuals' reported behaviour change.
The toolkit was well received by users who reported increased confidence in communication around end-of-life matters. 59.3% of users reported making a behaviour change over the previous 4 weeks; 70.8% of those who had not made a change reported they intended to in the near future. Against expectation, the toolkit's appeal went beyond its intended audience in acute hospital settings, for example, personal care workers in aged care settings.
Despite study limitations (self-report of a small, self-selected sample), these early findings suggest that the toolkit has potential to positively impact on end-of-life care practices. However, additional evaluation is needed to determine whether such a toolkit can positively impact on practice and on patient experience at the end of life.
本研究旨在确定一个以行动为导向的工具包在支持急性医院环境中与优质临终关怀相关的行为改变方面的有效性。该工具包是为补充在线临终关怀教育计划而开发的。
通过对国际上关于临终的同行评审文献进行综述来开发工具包。在4周内将工具包分发给了428名澳大利亚医疗保健专业人员。向所有收件人发送了在线调查问卷;共收到65份回复(回复率为16%,不包括无法投递的电子邮件)。使用目的抽样法进行了10次半结构化访谈,以确保获取一系列观点。评估的重点是调查:(1)用户对工具包的反应;(2)个人报告的行为改变。
工具包受到了用户的好评,他们表示在围绕临终问题的沟通方面信心增强。59.3%的用户报告在过去4周内有行为改变;70.8%没有做出改变的用户表示他们打算在不久的将来做出改变。出乎意料地是,该工具包的吸引力超出了其在急性医院环境中的预期受众,例如老年护理机构中的个人护理人员。
尽管本研究存在局限性(小样本、自我选择样本的自我报告),但这些早期研究结果表明该工具包有可能对临终关怀实践产生积极影响。然而,需要进行更多评估,以确定这样一个工具包是否能对临终实践和患者体验产生积极影响。