Bruyère Research Institute, Ottawa, Canada; Department of Medicine, University of Ottawa, Ottawa, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Canada.
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada; Peter Munk Cardiac Centre, University Health Network, Toronto, Canada.
J Pain Symptom Manage. 2021 Sep;62(3):e9-e19. doi: 10.1016/j.jpainsymman.2021.02.026. Epub 2021 Feb 22.
Hospital-to-home transitions, particularly at the end of life, can be challenging for patients and their family caregivers. Therefore, there is a need to better understand gaps in expectations and experiences of these transitions. Theory can inform the creation of an intervention aimed at improving the hospital-to-home transition.
Longitudinal, prospective qualitative study with semistructured interviews at hospital discharge and three to four weeks after discharge home. We recruited adults receiving inpatient palliative care who were being discharged to home-based palliative care, and their family caregivers from two academic health centers in Toronto, Canada. Thirty-nine participants: 18 patients, 7 caregivers, and 7 patient-caregiver dyads participated. We conducted 52 interviews. We conducted a grounded theory qualitative study.
Through examining the expectations and subsequent experiences of the transition, and exploring the gaps between them, we identified various transitions needs: health and well-being needs, and practical needs (i.e., transportation, setting up the home for care, care providers in the home). Several enablers and disablers modified the likelihood of needs being met (e.g., caregiver role, education on symptom management, uncertainty, financial resources).
Our substantive grounded theory highlighted potentially measurable constructs that can be further tested. Future interventions should target the enablers/disablers to ensure health and well-being and practical needs are met in the transition.
对于患者及其家庭照顾者而言，医院到家庭的过渡，特别是在生命末期，可能具有挑战性。因此，需要更好地了解这些过渡的期望和体验差距。理论可以为创建旨在改善医院到家庭过渡的干预措施提供信息。
1）探讨接受姑息治疗的患者和照顾者在医院到家庭过渡期间的期望和随后的体验，以及 2）构建实质性扎根理论，从患者和照顾者的角度增强对医院到家庭过渡的理解。
这是一项纵向、前瞻性定性研究，在出院时和出院回家后三到四周进行半结构化访谈。我们从加拿大多伦多的两家学术医疗中心招募了正在接受姑息治疗的住院患者，这些患者将被转到家庭姑息治疗，以及他们的家庭照顾者。39 名参与者：18 名患者、7 名照顾者和 7 名患者-照顾者二人组参与了研究。我们进行了 52 次访谈。我们进行了一项扎根理论定性研究。
通过检查过渡的期望和随后的体验，并探讨它们之间的差距，我们确定了各种过渡需求：健康和福祉需求以及实际需求（即，交通、为护理设置家庭、家庭中的护理提供者）。一些促进因素和阻碍因素改变了满足需求的可能性（例如，照顾者角色、症状管理教育、不确定性、财务资源）。
我们的实质性扎根理论突出了可以进一步测试的潜在可衡量的结构。未来的干预措施应针对促进因素/阻碍因素，以确保在过渡期间满足健康和福祉以及实际需求。
