Saurman Emily, Lyle David, Wenham Sarah, Cumming Melissa
Broken Hill University Department of Rural Health, University of Sydney, Corrindah Court, PO Box 457, Broken Hill, NSW 2880, Australia
Far West Local Health District, Broken Hill Health Service, Thomas Street, Broken Hill, NSW 2880, Australia
Rural Remote Health. 2019 Feb;19(1):4625. doi: 10.22605/RRH4625. Epub 2019 Feb 12.
All healthcare providers can influence the delivery and outcome of a palliative approach to care, ensuring that everyone has 'equitable access to quality care based on assessed need as they approach and reach the end-of-life'. This study mapped the delivery of palliative care in far west New South Wales (NSW), Australia, with objectives to: identify who was involved in providing such care in the Far West Local Health District (FWLHD), how they connect, and any gaps in the network describe what care was provided and identify any challenges to care provision. The mapping process and outcomes can be used to guide the implementation of new models of care by building on the localised knowledge of current networks, provision of care and challenges.
Semi-structured interviews were undertaken with members of the specialist palliative care service and generalist healthcare providers within the FWLHD. Fifteen interviews were conducted over 7 months. Content analyses of interview transcripts identified processes and challenges as well as improvements for care. A network analysis was conducted to identify unidirectional connections and 'map' the services.
The vast network demonstrates extensive long-term involvement in palliative care as well as established connections and opportunities for improving communication between the services and providers involved in palliative care. Palliative practice is varied and challenging within the network; challenges include communication, early identification and education. Mapping the existing networks, resources and relationships proved invaluable to guide the implementation of a palliative approach to care.
The implementation of a palliative approach, as with any service model, requires agreement and engagement across relevant healthcare organisations, services and providers. Mapping and understanding the network of providers (and organisations) that support healthcare delivery before implementing new models of care will identify strengths and gaps within the network. This knowledge will then support new and integrated connections that enhance the provision of care so that it is acceptable, fit for purpose and regionally responsive.
所有医疗服务提供者都能影响姑息治疗方法的实施及效果，确保每个人在临近和进入生命终末期时，都能“根据评估需求公平获得优质护理”。本研究描绘了澳大利亚新南威尔士州（NSW）最西部地区姑息治疗的实施情况，目标如下：确定在最西部地方卫生区（FWLHD）中参与提供此类护理的人员、他们如何建立联系以及网络中存在的任何差距；描述所提供的护理内容，并确定护理提供过程中存在的任何挑战。通过利用当前网络、护理提供情况和挑战的本地化知识，映射过程和结果可用于指导新护理模式的实施。
对FWLHD内的专科姑息治疗服务成员和全科医疗服务提供者进行了半结构化访谈。在7个月内进行了15次访谈。对访谈记录进行内容分析，确定了护理过程、挑战以及改进措施。进行了网络分析，以确定单向联系并“绘制”服务网络。
庞大的网络显示出在姑息治疗方面的广泛长期参与，以及姑息治疗服务和提供者之间已建立的联系以及改善沟通的机会。网络内的姑息治疗实践各不相同且具有挑战性；挑战包括沟通、早期识别和教育。事实证明，绘制现有网络、资源和关系对于指导姑息治疗方法的实施非常宝贵。
与任何服务模式一样，姑息治疗方法的实施需要相关医疗保健组织、服务和提供者达成共识并积极参与。在实施新的护理模式之前，绘制并了解支持医疗服务提供的提供者（和组织）网络，将识别网络中的优势和差距。这些知识将支持建立新的整合联系，从而加强护理提供，使其可接受、符合目的并能对地区需求做出响应。
