临终关怀出院：家庭和临终关怀工作人员的经验。
Live hospice discharge: Experiences of families, and hospice staff.
机构信息
College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, UT, 84112, USA.
Department of Sociology, University of Utah, 390 1530 E #301 Salt Lake City, UT, 84112, USA.
出版信息
Patient Educ Couns. 2021 Aug;104(8):2054-2059. doi: 10.1016/j.pec.2021.01.002. Epub 2021 Jan 5.
OBJECTIVE
To examine live hospice discharge prevalence and experiences of families and hospice staff. Hospice eligibility is based on a cancer model where decline and death are predicable. Decline is less predictable for diagnoses such as dementia, frequently resulting in involuntary live hospice discharge.
METHODS
A mixed-method integration of hospice 2013-17 admission/discharge data, 5 family interviews, hospice discipline-specific focus groups (3 aides, 2 nurses, 1 administrator interview) and a discipline-combined focus group (all 6 staff; each staff participant engaged in two data collection experiences).
RESULTS
5648 hospice admissions occurred between 2013-17; 795 patients experienced live discharge. The most prevalent admitting diagnosis was cancer, the most prevalent live discharge diagnosis was dementia. Family caregiver themes were Attitude and experience with hospice, Discharge experience, and Continued need/desire for hospice following discharge. Staff themes were Discharge circumstances, Regulatory guidelines, and Changing practice to meet regulatory guidelines.
CONCLUSION
Involuntary live hospice discharge precludes patient-centered care due to policy constraints, especially for those with noncancer diagnoses. Families and staff noted the paradox of beneficial hospice care, yet this care resulted in ineligibility for continued hospice services.
PRACTICE IMPLICATIONS
Transparent, patient-family-staff communication (including CNAs) facilitates hospice live discharge planning. Hospice service eligibility policy changes are needed.
目的
调查临终关怀出院的现患率以及患者家庭和临终关怀工作人员的体验。临终关怀的资格是基于癌症模型，即衰退和死亡是可以预测的。对于痴呆症等诊断，衰退的可预测性较低，这经常导致非自愿的临终关怀出院。
方法
对 2013 年至 2017 年临终关怀入院/出院数据、5 个家庭访谈、临终关怀特定专业的焦点小组（3 个助手、2 个护士、1 个管理员访谈）以及一个跨专业焦点小组（所有 6 名工作人员；每位工作人员都参与了两次数据收集体验）进行了混合方法的整合。
结果
2013 年至 2017 年期间发生了 5648 例临终关怀入院；795 名患者经历了非自愿出院。最常见的入院诊断是癌症，最常见的非自愿出院诊断是痴呆症。家庭照顾者的主题包括对临终关怀的态度和体验、出院体验以及出院后继续需要/渴望接受临终关怀。工作人员的主题包括出院情况、监管指南以及为满足监管指南而改变实践。
结论
由于政策限制，非自愿的临终关怀出院使以患者为中心的护理变得不可能，特别是对于那些患有非癌症诊断的患者。家庭和工作人员注意到有益的临终关怀护理的悖论，但这种护理导致他们失去了继续接受临终关怀服务的资格。
实践意义
透明、患者-家庭-工作人员的沟通（包括 CNA）有助于临终关怀的非自愿出院计划。需要改变临终关怀服务资格政策。
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