School of Nursing, University of British Columbia Okanagan, 1147 Research Road Arts 3rd Floor, Kelowna, BC, V1V 1V7, Canada.
Faculty of Nursing University of Alberta, 3-141 ECHA 11405 87th Ave, Edmonton, Alberta, T6G1C9, Canada.
BMC Palliat Care. 2020 May 22;19(1):72. doi: 10.1186/s12904-020-00578-1.
Nav-CARE is a volunteer-led intervention designed to build upon strategic directions in palliative care: a palliative approach to care, a public health/compassionate community approach to care, and enhancing the capacity of volunteerism. Nav-CARE uses specially trained volunteers to provide lay navigation for older persons and family living at home with advanced chronic illness. The goal of this study was to better understand the implementation factors that influenced the utilization of Nav-CARE in eight diverse Canadian contexts.
This was a Knowledge to Action study using the planned action cycle for Nav-CARE developed through previous studies. Participants were eight community-based hospice societies located in diverse geographic contexts and with diverse capacities. Implementation data was collected at baseline, midpoint, and endpoint using qualitative individual and group interviews. Field notes of all interactions with study sites were also used as part of the data set. Data was analyzed using qualitative descriptive techniques. The study received ethical approval from three university behavioural review boards. All participants provided written consent.
At baseline, stakeholders perceived Nav-CARE to be a good fit with the strategic directions of their organization by providing early palliative support, by facilitating outreach into the community and by changing the public perception of palliative care. The contextual factors that determined the ease with which Nav-CARE was implemented included the volunteer coordinator champion, organizational capacity and connection, the ability to successfully recruit older persons, and the adequacy of volunteer preparation and mentorship.
This study highlighted the importance of community-based champions for the success of volunteer-led initiatives and the critical need for support and mentorship for both volunteers and those who lead them. Further, although the underutilization of hospice has been widely recognized, it is vital to recognize the limitations of their capacity. New initiatives such as Nav-CARE, which are designed to enhance their contributions to palliative care, need to be accompanied by adequate resources. Finally, this study illustrated the need to think carefully about the language and role of hospice societies as palliative care moves toward a public health approach to care.
Nav-CARE 是一项由志愿者主导的干预措施，旨在建立在姑息治疗的战略方向之上：以姑息治疗的方法照顾患者，以公共卫生/富有同情心的社区方法照顾患者，并增强志愿服务的能力。Nav-CARE 使用经过专门培训的志愿者为患有晚期慢性疾病、在家中生活的老年人及其家属提供基本的导航服务。本研究的目的是更好地了解影响 Nav-CARE 在八个不同加拿大背景下利用的实施因素。
这是一项知识转化行动研究，使用了之前研究中为 Nav-CARE 制定的计划行动周期。参与者是位于不同地理背景和具有不同能力的八个基于社区的临终关怀协会。使用定性个体和小组访谈，在基线、中点和终点收集实施数据。研究现场的所有互动的现场记录也被用作数据集的一部分。使用定性描述性技术对数据进行分析。该研究得到了三个大学行为审查委员会的伦理批准。所有参与者均提供了书面同意。
在基线时，利益相关者认为 Nav-CARE 通过提供早期姑息治疗支持、促进向社区外展以及改变公众对姑息治疗的看法，与组织的战略方向非常契合。决定 Nav-CARE 实施难易程度的背景因素包括志愿者协调员的拥护者、组织能力和联系、成功招募老年人的能力，以及志愿者准备和指导的充分性。
本研究强调了社区基础拥护者对志愿者主导倡议成功的重要性，以及为志愿者和领导他们的人提供支持和指导的迫切需要。此外，尽管广泛认识到临终关怀的利用不足，但认识到其能力的局限性至关重要。像 Nav-CARE 这样旨在增强其对姑息治疗贡献的新举措，需要有足够的资源支持。最后，本研究说明了在姑息治疗向公共卫生护理方法转变的过程中，需要仔细考虑临终关怀协会的语言和角色。
