Hall Alex, Ewing Gail, Rowland Christine, Grande Gunn
School of Health Sciences, University of Manchester, Manchester, UK.
National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care Greater Manchester (CLAHRC GM), Salford Royal Foundation NHS Trust, Salford, UK.
Palliat Med. 2020 Sep;34(8):1088-1096. doi: 10.1177/0269216320930935. Epub 2020 Jun 3.
Informal carers are essential in enabling discharge home from hospital at end of life and supporting palliative patients at home, but are often ill-prepared for the role. Carers' support needs are rarely considered at discharge. If carers are less able to cope with home care, patient care may suffer and readmission may become more likely.
To investigate the implementation of an evidence-based Carer Support Needs Assessment Tool (CSNAT) intervention to support carers during hospital discharge at end of life.
Longitudinal qualitative study with thematic analysis.
SETTING/PARTICIPANTS: One National Health Service Trust in England: 12 hospital practitioners, one hospital administrator and four community practitioners. We provided training in CSNAT intervention use and implementation. Practitioners delivered the intervention for 6 months. Data collection was conducted in three phases: (1) pre-implementation interviews exploring understandings, anticipated benefits and challenges of the intervention; (2) observations of team meetings and review of intervention procedures and (3) follow-up interviews exploring experiences of working with the intervention.
Despite efforts from practitioners, implementation was challenging. Three main themes captured facilitators and barriers to implementation: (1) structure and focus within carer support; (2) the 'right' people to implement the intervention and (3) practical implementation challenges.
Structure and focus may facilitate implementation, but the dominance of outcomes measurement and performance metrics in health systems may powerfully frame perceptions of the intervention and implementation decisions. There is uncertainty over who is best-placed or responsible for supporting carers around hospital discharge, and challenges in connecting with carers prior to discharge.
非正式照护者对于临终患者从医院出院回家以及在家中支持姑息治疗患者至关重要，但他们往往对该角色准备不足。在患者出院时，照护者的支持需求很少被考虑。如果照护者应对家庭护理的能力较弱，患者护理可能会受到影响，再次入院的可能性也可能增加。
调查基于证据的照护者支持需求评估工具（CSNAT）干预措施在临终患者出院期间支持照护者的实施情况。
采用主题分析的纵向定性研究。
背景/参与者：英格兰的一个国民医疗服务信托基金：12名医院从业者、1名医院管理人员和4名社区从业者。我们提供了CSNAT干预措施使用和实施方面的培训。从业者实施该干预措施6个月。数据收集分三个阶段进行：（1）实施前访谈，探讨对干预措施的理解、预期益处和挑战；（2）观察团队会议并审查干预程序；（3）后续访谈，探讨使用该干预措施的工作经验。
尽管从业者付出了努力，但实施仍具有挑战性。三个主要主题涵盖了实施的促进因素和障碍：（1）照护者支持的结构和重点；（2）实施干预措施的“合适”人员；（3）实际实施挑战。
结构和重点可能有助于实施，但卫生系统中结果测量和绩效指标的主导地位可能会有力地塑造对干预措施和实施决策的看法。对于在出院前后谁最适合或负责支持照护者存在不确定性，并且在出院前与照护者建立联系也存在挑战。
