Marie Curie Hospice Edinburgh, 45 Frogston Road West, Edinburgh, EH10 7DR, UK.
Primary Palliative Care Research Group, Usher Institute, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK.
BMC Palliat Care. 2021 Jan 15;20(1):18. doi: 10.1186/s12904-020-00700-3.
Specialist palliative care (SPC) providers tend to use the term 'complex' to refer to the needs of patients who require SPC. However, little is known about complex needs on first referral to a SPC service. We examined which needs are present and sought the perspectives of healthcare professionals on the complexity of need on referral to a hospice service.
Multi-site sequential explanatory mixed method study consisting of a case-note review and focus groups with healthcare professionals in four UK hospices.
Documentation relating to 239 new patient referrals to hospice was reviewed; and focus groups involving 22 healthcare professionals conducted. Most patients had two or more needs documented on referral (96%); and needs were recorded across two or more domains for 62%. Physical needs were recorded for 91% of patients; psychological needs were recorded for 59%. Spiritual needs were rarely documented. Referral forms were considered limited for capturing complex needs. Referrals were perceived to be influenced by the experience and confidence of the referrer and the local resource available to meet palliative care needs directly.
Complexity was hard to detail or to objectively define on referral documentation alone. It appeared to be a term used to describe patients whom primary or secondary care providers felt needed SPC knowledge or support to meet their needs. Hospices need to provide greater clarity regarding who should be referred, when and for what purpose. Education and training in palliative care for primary care nurses and doctors and hospital clinicians could reduce the need for referral and help ensure that hospices are available to those most in need of SPC input.
专科姑息治疗（SPC）提供者倾向于使用“复杂”一词来指代需要 SPC 的患者的需求。然而，对于初次转介至 SPC 服务的患者的复杂需求，我们知之甚少。我们研究了存在哪些需求，并征求了医疗保健专业人员对转介至临终关怀服务时需求复杂性的看法。
这是一项多地点顺序解释性混合方法研究，包括对四家英国临终关怀机构的病历回顾和医疗保健专业人员的焦点小组。
对 239 例新患者转介至临终关怀的病历进行了审查；并对 22 名医疗保健专业人员进行了焦点小组讨论。大多数患者在转介时记录了两个或更多的需求（96%）；有 62%的患者在两个或更多领域记录了需求。91%的患者记录了身体需求；59%的患者记录了心理需求。很少记录精神需求。转介表被认为在捕捉复杂需求方面有局限性。转介被认为受到转介者的经验和信心以及当地直接满足姑息治疗需求的资源的影响。
仅在转介文件上很难详细说明或客观定义复杂性。它似乎是一个用来描述初级或二级保健提供者认为需要 SPC 知识或支持来满足其需求的患者的术语。临终关怀机构需要更清楚地说明谁应该转介、何时以及出于什么目的转介。对初级保健护士和医生以及医院临床医生进行姑息治疗教育和培训可以减少转介的需求，并有助于确保临终关怀机构能够为最需要 SPC 投入的患者提供服务。
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