Yale University School of Nursing, Orange, Connecticut, USA.
VA Connecticut Healthcare System, West Haven, Connecticut, USA.
J Am Geriatr Soc. 2021 Mar;69(3):587-592. doi: 10.1111/jgs.16993. Epub 2021 Jan 6.
BACKGROUND/OBJECTIVE: The COVID-19 pandemic has resulted in rapid changes to end-of-life care for hospitalized older adults and their families, including visitation restrictions. We examined bereaved families' perceptions of the quality of end-of-life communication among Veterans, families and staff in Veterans Affairs (VA) medical centers during the COVID-19 pandemic.
Qualitative descriptive study using data from a survey of bereaved family members of Veterans administered from March-June 2020. Data were analyzed using qualitative content analysis.
VA medical centers with the highest numbers of COVID-19 cases during the study period.
Next-of-kin of 328 Veterans who died in one of 37 VA medical centers' acute care, intensive care, nursing home, or hospice units.
Open-ended survey questions (response rate = 37%) about family member's perceptions of: (1) communication with the healthcare team about the patient, (2) communication with the patient, and (3) use of remote communication technologies.
Bereaved family members identified contextual factors perceived to impact communication quality including: allowing family at the bedside when death is imminent, fears that the patient died alone, and overall perceptions of VA care. Characteristics of perceived high-quality communication included staff availability for remote communication and being kept informed of the patient's condition and plan of care. Low-quality communication with staff was perceived to result from limited access to staff, insufficient updates regarding the patient's condition, and when the family member was not consulted about care decision-making. Communication quality with the patient was facilitated or impeded by the availability and use of video-enabled remote technologies.
Communication between patients, families, and healthcare teams at the end of life remains critically important during times of limited in-person visitation. Families report that low-quality communication causes profound distress that can affect the quality of dying and bereavement. Innovative strategies are needed to ensure that high-quality communication occurs despite pandemic-related visitation restrictions.
背景/目的：COVID-19 大流行导致住院老年患者及其家属的临终关怀迅速发生变化，包括探视限制。我们调查了在 COVID-19 大流行期间，退伍军人事务部（VA）医疗中心的丧亲家庭对退伍军人、家庭和工作人员之间的临终沟通质量的看法。
使用 2020 年 3 月至 6 月期间对退伍军人的丧亲家庭成员进行的调查数据的定性描述性研究。使用定性内容分析对数据进行分析。
在研究期间 COVID-19 病例最多的 VA 医疗中心。
328 名在 37 个 VA 医疗中心的急症护理、重症监护、疗养院或临终关怀病房死亡的退伍军人的近亲。
关于家庭成员对以下方面看法的开放式调查问题（应答率=37%）：（1）与医疗团队就患者进行沟通，（2）与患者进行沟通，以及（3）使用远程沟通技术。
丧亲家庭成员确定了影响沟通质量的背景因素，包括：当死亡迫在眉睫时允许家属在床边、担心患者独自死亡以及对 VA 护理的整体看法。被认为具有高质量沟通的特征包括工作人员可进行远程沟通以及及时了解患者的病情和护理计划。与工作人员的低质量沟通被认为是由于有限的工作人员访问、对患者病情的更新不足以及在护理决策方面未咨询家属造成的。可视频的远程技术的可用性和使用促进或阻碍了与患者的沟通质量。
在限制亲自探视的时期，患者、家属和医疗团队之间的临终沟通仍然至关重要。家庭报告说，低质量的沟通会引起极大的困扰，从而影响临终和丧亲的质量。需要创新策略来确保即使在大流行相关的探视限制下，仍能进行高质量的沟通。
