影响临终关怀医院服务质量的因素——对挪威 i-CODE 调查中自由文本评论的定性分析。
Factors affecting quality of end-of-life hospital care - a qualitative analysis of free text comments from the i-CODE survey in Norway.
机构信息
Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway.
Department of Clinical Medicine K1, University of Bergen, Bergen, Norway.
出版信息
BMC Palliat Care. 2020 Jul 7;19(1):98. doi: 10.1186/s12904-020-00609-x.
BACKGROUND
The ERANet-LAC CODE (Care Of the Dying Evaluation) international survey assessed quality of care for dying cancer patients in seven countries, by use of the i-CODE questionnaire completed by bereaved relatives. The aim of this sub study was to explore which factors improve or reduce quality of end-of-life (EOL) care from Norwegian relatives' point of view, as expressed in free text comments.
METHODS
194 relatives of cancer patients dying in seven Norwegian hospitals completed the i-CODE questionnaire 6-8 weeks after bereavement; recruitment period 14 months; response rate 58%. Responders were similar to non-responders in terms of demographic details.104 participants (58% spouse/partner) added free text comments, which were analyzed by systematic text condensation.
RESULTS
Of the 104 comments, 45% contained negative descriptions, 27% positive and 23% mixed. 78% described previous experiences, whereas 22% alluded to the last 2 days of life. 64% of the comments represented medical/surgical/oncological wards and 36% palliative care units. Four main categories were developed from the free text comments: 1) Participants described how attentive care towards the practical needs of patients and relatives promoted dignity at the end of life, which could easily be lost when this awareness was missing. 2) They experienced that lack of staff, care continuity, professional competence or healthcare service coordination caused uncertainty and poor symptom alleviation. 3) Inadequate information to patient and family members generated unpredictable and distressing final illness trajectories. 4) Availability and professional support from healthcare providers created safety and enhanced coping in a difficult situation.
CONCLUSIONS
Our findings suggest that hospitals caring for cancer patients at the end of life and their relatives, should systematically identify and attend to practical needs, as well as address important organizational issues. Education of staff members ought to emphasize how professional conduct and communication fundamentally affect patient care and relatives' coping.
背景
ERANet-LAC CODE（临终关怀评估）国际调查通过使用 i-CODE 问卷由失去亲人的亲属来评估七个国家癌症临终患者的护理质量。本研究的目的是探讨从挪威亲属的角度来看，哪些因素可以改善或降低临终关怀的质量，这些因素是通过对自由文本评论的分析得出的。
方法
194 名在挪威七家医院去世的癌症患者的亲属在丧亲后 6-8 周内完成了 i-CODE 问卷；招募期为 14 个月；回应率为 58%。应答者在人口统计学细节方面与非应答者相似。104 名参与者（58%为配偶/伴侣）添加了自由文本评论，这些评论通过系统文本凝结进行了分析。
结果
在 104 条评论中，45%包含负面描述，27%为正面描述，23%为混合描述。78%描述了之前的经历，而 22%则暗示了生命的最后两天。64%的评论涉及医疗/外科/肿瘤病房，36%涉及姑息治疗病房。从自由文本评论中得出了四个主要类别：1）参与者描述了对患者和亲属实际需求的关注如何促进临终时的尊严，而当缺乏这种意识时，尊严很容易丧失。2）他们体验到缺乏工作人员、护理连续性、专业能力或医疗保健服务协调导致了不确定性和症状缓解不佳。3）对患者和家庭成员的信息不足导致了不可预测和痛苦的终末期疾病轨迹。4）医疗保健提供者的可用性和专业支持在困难情况下创造了安全并增强了应对能力。
结论
我们的研究结果表明，照顾癌症临终患者及其亲属的医院应系统地识别和满足实际需求，并解决重要的组织问题。对工作人员的教育应强调专业行为和沟通如何从根本上影响患者护理和亲属的应对。
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