The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
CUHK Jockey Club Institute of Ageing, The Chinese University of Hong Kong, Hong Kong, China.
Int J Environ Res Public Health. 2020 Jul 16;17(14):5130. doi: 10.3390/ijerph17145130.
In response to population aging, there is a need for health systems to focus on care for chronic disease, specifically palliative care, while focusing on people-centered care. The objective of this study is to explore the healthcare system enablers and barriers to the provision of quality palliative and end-of-life care from the perspective of healthcare professionals.
Using purposive sampling, fifteen focus group interviews and nine individual interviews involving 72 healthcare providers were conducted. Primary qualitative data were collected between May 2016 and July 2017. All recorded discussions were transcribed verbatim and analyzed. A thematic framework was developed.
The provision of quality palliative and end-of-life care is influenced by the interaction and integration of nine sub-themes under four identified themes: (1) political context; (2) organization setting; (3) support to patients, caregivers, and family members, and (4) healthcare workers and the public.
Integration of palliative and end-of-life care is an important pillar of healthcare service to improve quality of life by addressing patients' values, wishes and preference, and assist their family to handle challenges at the end stage of life. Further improvements to the service framework would be required, specifically in the political framework, multidisciplinary approach, and readiness and competence in healthcare workers and community. These were highlighted in our study as key components in service provision to ensure that patients can receive continuous and integrated care between hospitals and the community as well as dignified care at the end stage of life.
为应对人口老龄化，卫生系统需要将重点放在慢性病的护理上，特别是姑息治疗，并注重以人为本的护理。本研究旨在从医护人员的角度探讨提供优质姑息治疗和临终关怀服务的卫生系统促进因素和障碍。
采用目的抽样法，于 2016 年 5 月至 2017 年 7 月期间，进行了 15 次焦点小组访谈和 9 次个人访谈，共涉及 72 名医护人员。主要收集定性数据，所有记录的讨论均逐字转录并进行分析。制定了主题框架。
提供优质姑息治疗和临终关怀服务受到四个已确定主题下九个子主题的相互作用和整合的影响：（1）政治背景；（2）组织环境；（3）对患者、照顾者和家庭成员的支持；（4）医护人员和公众。
姑息治疗和临终关怀的整合是医疗服务的一个重要支柱，通过解决患者的价值观、愿望和偏好，提高生活质量，并帮助其家属应对生命终末期的挑战。需要进一步改进服务框架，特别是在政治框架、多学科方法以及医护人员和社区的准备和能力方面。这些在我们的研究中被强调为服务提供的关键组成部分，以确保患者能够在医院和社区之间获得连续和综合的护理，并在生命终末期得到有尊严的护理。
