Department of Family and Community Medicine, University of Toronto, Toronto, Canada.
Department of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.
J Pain Symptom Manage. 2021 Aug;62(2):233-241. doi: 10.1016/j.jpainsymman.2020.12.019. Epub 2020 Dec 29.
Continuity of care is important at improving the patient experience and reducing unnecessary hospitalizations when transitioning across care settings, especially at the end of life.
To explore patient and caregiver understanding and valuation of "continuity of care" while transitioning from an in-hospital to a home-based palliative care team.
Longitudinal qualitative design using semistructured interviews conducted with patients and their caregivers before and after transitioning from hospital to palliative care at home. Interviews were audio-recorded and transcribed verbatim. Data were analyzed using thematic analysis within a postpositivist framework. Thirty-nine participants (18 patients, seven caregivers, and seven patient-caregiver dyads) were recruited from two acute care hospitals, wherein they received care from an inpatient palliative care consultation team and transitioned to home-based palliative care.
Patients had a mean age of 68 years, 60% were female and 60% had a diagnosis of cancer. Caregivers had a mean age of 62 years and 50% were female. Participants perceived continuity of care to occur in three ways, depending on which stage they were at in their hospital-to-home transition. In hospital, continuity of care was experienced, as consistency of information exchanged between providers. During the transition from hospital to home, continuity of care was experienced as consistency of treatments. When receiving home-based palliative care, continuity of care was experienced as having consistent providers.
Patients' and their caregivers' valuation of continuity of care was dependent on their stage of the hospital-to-home transition. Optimizing continuity of care requires an integrated network of providers with reliable information transfer and communication.
在跨越医疗照护场所时，连续性照护对于改善病患体验和减少不必要的住院治疗至关重要，尤其是在临终阶段。
探讨患者及其照护者在从住院过渡到家庭为基础的姑息治疗团队时，对“连续性照护”的理解和重视程度。
采用纵向定性设计，对从医院过渡到家庭姑息治疗的患者及其照护者在过渡前后进行半结构化访谈。访谈进行录音并逐字记录。在实证主义框架内采用主题分析方法进行数据分析。从两家急性护理医院招募了 39 名参与者（18 名患者、7 名照护者和 7 名患者-照护者二人组），他们在那里接受了住院姑息治疗咨询团队的治疗，并过渡到家庭为基础的姑息治疗。
患者的平均年龄为 68 岁，60%为女性，60%患有癌症。照护者的平均年龄为 62 岁，50%为女性。参与者认为连续性照护有三种方式，具体取决于他们在从医院到家庭过渡中的阶段。在医院，连续性照护表现为提供者之间交换信息的一致性。在从医院过渡到家庭期间，连续性照护表现为治疗的一致性。在接受家庭为基础的姑息治疗时，连续性照护表现为有一致的提供者。
患者及其照护者对连续性照护的重视程度取决于他们在从医院到家庭过渡中的阶段。优化连续性照护需要一个具有可靠信息传递和沟通的提供者的综合网络。
