Faculty of Medicine, School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia.
SWS Clinical School, The Simpson Centre for Health Services Research, University of New South Wales, Sydney, New South Wales, Australia.
Health Expect. 2019 Jun;22(3):405-414. doi: 10.1111/hex.12860. Epub 2019 Jan 6.
As older adults approach the end-of-life (EOL), many are faced with complex decisions including whether to use medical advances to prolong life. Limited information exists on the priorities of older adults at the EOL.
This study aimed to explore patient and family experiences and identify factors deemed important to quality EOL care.
A descriptive qualitative study involving three focus group discussions (n = 18) and six in-depth interviews with older adults suffering from either a terminal condition and/or caregivers were conducted in NSW, Australia. Data were analysed thematically.
Seven major themes were identified as follows: quality as a priority, sense of control, life on hold, need for health system support, being at home, talking about death and competent and caring health professionals. An underpinning priority throughout the seven themes was knowing and adhering to patient's wishes.
Our study highlights that to better adhere to EOL patient's wishes a reorganization of care needs is required. The readiness of the health system to cater for this expectation is questionable as real choices may not be available in acute hospital settings. With an ageing population, a reorganization of care which influences the way we manage terminal patients is required.
随着老年人接近生命末期（EOL），许多人面临着复杂的决策，包括是否使用医疗进步来延长生命。关于老年人在生命末期的优先事项的信息有限。
本研究旨在探讨患者和家属的经验，并确定被认为对高质量生命末期护理重要的因素。
在澳大利亚新南威尔士州进行了一项描述性定性研究，包括三次焦点小组讨论（n=18）和六次与患有终末期疾病和/或护理人员的老年人的深入访谈。数据进行了主题分析。
确定了以下七个主要主题：质量优先、控制感、生活暂停、对卫生系统支持的需求、在家、谈论死亡以及有能力和关怀的卫生专业人员。七个主题的一个潜在优先事项是了解和遵守患者的意愿。
我们的研究强调，为了更好地遵守生命末期患者的意愿，需要对护理进行重新组织。卫生系统准备满足这一期望是值得怀疑的，因为在急性医院环境中可能无法提供真正的选择。随着人口老龄化，需要重新组织护理，影响我们管理终末期患者的方式。
