University of Liverpool Management School, Chatham Street, Liverpool, L69 7ZH, UK.
BMC Palliat Care. 2020 Jul 10;19(1):104. doi: 10.1186/s12904-020-00612-2.
Evaluation of palliative care services is crucial in order to ensure high quality care and to plan future services in light of growing demand. There is also an acknowledgement of the need to better understand patient experiences as part of the paradigm shift from paternalistic professional and passive patient to a more collaborative partnership. However, while clinical decision-making is well-developed, the science of the delivery of care is relatively novel for most clinicians. We therefore introduce the Trajectory Touchpoint Technique (TTT), a systematic methodology designed using service delivery models and theories, for capturing the voices of palliative care service users.
We used design science research as our overarching methodology to build our Trajectory Touchpoint Technique. We also incorporated a range of kernel theories and service design models from the wider social sciences. We developed and tested our Trajectory Touchpoint Technique with palliative care patients and their families (n = 239) in collaboration with different hospices and hospital-based palliative care providers (n = 8).
The Trajectory Touchpoint Technique is user-friendly, enables systematic data collection and analysis, and incorporates all tangible and intangible dimensions of palliative care important to the service user. These dimensions often go beyond clinical care to encompass wider aspects that are important to the people who use the service. Our collaborating organisations have already begun to make changes to their service delivery based on our results.
The Trajectory Touchpoint Technique overcomes several limitations of other palliative care evaluation methods, while being more comprehensive. The new technique incorporates physical, psychosocial, and spiritual aspects of palliative care, and is user-friendly for inpatients, outpatients, families, and the bereaved. The new technique has been tested with people who have a range of illnesses, in a variety of locations, among people with learning disabilities and low levels of literacy, and with children as well as adults. The Trajectory Touchpoint Technique has already uncovered many previously unrecognised opportunities for service improvement, demonstrating its ability to shape palliative care services to better meet the needs of patients and their families.
为了确保高质量的护理并根据不断增长的需求规划未来的服务，对姑息治疗服务进行评估至关重要。人们也认识到需要更好地了解患者的体验，这是从家长式专业和被动患者向更具协作性的伙伴关系转变的一部分。然而，虽然临床决策制定已经很完善，但对于大多数临床医生来说，护理服务的提供仍然是一个相对较新的科学领域。因此，我们引入了轨迹接触点技术（TTT），这是一种使用服务提供模型和理论设计的系统方法，用于捕捉姑息治疗服务使用者的声音。
我们使用设计科学研究作为我们的总体方法来构建我们的轨迹接触点技术。我们还结合了来自更广泛的社会科学的一系列核心理论和服务设计模型。我们与不同的临终关怀机构和医院姑息治疗提供者（n=8）合作，使用姑息治疗患者及其家属（n=239）对我们的轨迹接触点技术进行了开发和测试。
轨迹接触点技术易于使用，能够进行系统的数据收集和分析，并纳入了对服务使用者重要的姑息治疗的所有有形和无形维度。这些维度通常超出了临床护理的范围，涵盖了对使用服务的人很重要的更广泛的方面。我们合作的机构已经根据我们的结果开始对其服务提供做出改变。
轨迹接触点技术克服了其他姑息治疗评估方法的几个局限性，同时更加全面。新技术纳入了姑息治疗的身体、心理社会和精神方面，对住院患者、门诊患者、家属和丧亲者都很友好。新技术已经在患有各种疾病的人群中、在各种地点、在有学习障碍和低识字水平的人群中以及在儿童和成人中进行了测试。轨迹接触点技术已经发现了许多以前未被识别的服务改进机会，证明了其能够塑造姑息治疗服务，以更好地满足患者及其家属的需求。
