在医院环境中实施严重疾病护理计划前后临床医生与患者及其家属沟通质量的回顾性图表研究。
Quality of clinicians' conversations with patients and families before and after implementation of the Serious Illness Care Program in a hospital setting: a retrospective chart review study.
机构信息
Michael G. DeGroote School of Medicine (Ma, Riehm), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Harvard Medical School (Bernacki, Paladino); Department of Psychosocial Oncology and Palliative Care (Bernacki), Dana-Farber Cancer Institute; Ariadne Labs (Bernacki, Paladino), Brigham and Women's Hospital and Harvard T.H. Chan School of Public Health; Department of Medicine (Bernacki, Paladino), Brigham and Women's Hospital, Boston, Mass.; Division of General Internal and Hospitalist Medicine (You), Trillium Health Partners, Mississauga, Ont.; Departments of Medicine and of Health Research Methods, Evidence, and Impact (You), McMaster University, Hamilton, Ont.
出版信息
CMAJ Open. 2020 Jun 19;8(2):E448-E454. doi: 10.9778/cmajo.20190193. Print 2020 Apr-Jun.
BACKGROUND
Seriously ill patients in hospital have indicated that better communication with practitioners is vital for improving care. The aim of this study was to assess whether the quality of conversations about serious illness improved after implementation of the Serious Illness Care Program (SICP).
METHODS
In this retrospective chart review study, we evaluated patients who were admitted to a medical ward at Hamilton General Hospital, had a stay of at least 48 hours, and were at risk for a lengthy stay or increased need for community-based services (inter-RAI Emergency Department Screener score of 5 or 6). The SICP study period was from Mar. 1, 2017, to Jan. 19, 2018. We used a validated codebook to assess the quality of documented conversations regarding serious illness for eligible patients before (usual care [control group]) and after SICP implementation (intervention group), specifically examining the following domains: patients' values and goals, understanding of prognosis and illness, end-of-life care planning, and code status or desire for other life-sustaining treatments.
RESULTS
The study sample included 56 patients in the control group and 56 patients in the intervention group. The overall quality of documented conversations about serious illness was significantly higher in the intervention group than in the control group ( < 0.001) and was significantly higher in the subdomains of values and goals ( < 0.001), understanding of prognosis and illness ( < 0.001) and life-sustaining treatments ( = 0.03) but not end-of-life care planning ( = 0.48).
INTERPRETATION
Implementation of the SICP in a hospital setting was associated with higher quality of documented conversations regarding serious illness with patients at high risk for clinical or functional deterioration. The SICP is transferable and adaptable to a hospital setting, and was associated with an increase in adherence to best practices compared to usual care.
背景
住院的重病患者表示，与医生更好地沟通对于改善护理至关重要。本研究旨在评估严重疾病护理计划（SICP）实施后，关于严重疾病的对话质量是否有所提高。
方法
在这项回顾性图表审查研究中，我们评估了入住汉密尔顿综合医院内科病房、住院时间至少 48 小时且有长期住院或增加社区服务需求风险（inter-RAI 急诊筛查评分 5 或 6）的患者。SICP 研究期间为 2017 年 3 月 1 日至 2018 年 1 月 19 日。我们使用经过验证的代码簿评估了符合条件的患者在 SICP 实施之前（常规护理[对照组]）和之后（干预组）关于严重疾病的记录对话的质量，具体检查了以下领域：患者的价值观和目标、对预后和疾病的理解、临终关怀计划以及代码状态或对其他维持生命的治疗的需求。
结果
研究样本包括对照组的 56 名患者和干预组的 56 名患者。干预组关于严重疾病的记录对话的整体质量明显高于对照组（<0.001），在价值观和目标（<0.001）、预后和疾病理解（<0.001）和维持生命的治疗（=0.03）方面明显更高，但在临终关怀计划方面没有明显差异（=0.48）。
解释
在医院环境中实施 SICP 与记录的关于严重疾病的对话质量更高相关，这些患者有临床或功能恶化的高风险。SICP 可转移且适用于医院环境，与常规护理相比，它与最佳实践的依从性增加相关。
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