Cumming School of Medicine, University of Calgary, Calgary, Canada.
Faculty of Science, University of British Columbia, Vancouver, Canada.
BMC Geriatr. 2021 May 22;21(1):326. doi: 10.1186/s12877-021-02271-1.
Optimal supportive end of life care for frail, older adults in long term care (LTC) homes involves symptom management, family participation, advance care plans, and organizational support. This 2-phase study aimed to combine multi-disciplinary opinions, build group consensus, and identify the top interventions needed to develop a supportive end of life care strategy for LTC.
A consensus-building approach was undertaken in 2 Phases. The first phase deployed modified Delphi questionnaires to address and transform diverse opinions into group consensus. The second phase explored and prioritized the interventions needed to develop a supportive end of life care strategy for LTC. Development of the Delphi questionnaire was based on findings from published results of physician perspectives of barriers and facilitators to optimal supportive end of life care in LTC, a literature search of palliative care models in LTC, and published results of patient, family and nursing perspectives of supportive end of life care in long term care. The second phase involved World Café Style workshop discussions. A multi-disciplinary purposive sample of individuals inclusive of physicians; staff, administrators, residents, family members, and content experts in palliative care, and researchers in geriatrics and gerontology participated in round one of the modified Delphi questionnaire. A second purposive sample derived from round one participants completed the second round of the modified Delphi questionnaire. A third purposive sample (including participants from the Delphi panel) then convened to identify the top priorities needed to develop a supportive end-of-life care strategy for LTC.
19 participants rated 75 statements on a 9-point Likert scale during the first round of the modified Delphi questionnaire. 11 participants (participation rate 58 %) completed the second round of the modified Delphi questionnaire and reached consensus on the inclusion of 71candidate statements. 35 multidisciplinary participants discussed the 71 statements remaining and prioritized the top clinical practice, communication, and policy interventions needed to develop a supportive end of life strategy for LTC.
Multi-disciplinary stakeholders identified and prioritized the top interventions needed to develop a 5-point supportive end of life care strategy for LTC.
为长期护理（LTC）机构中的体弱、老年患者提供最佳临终关怀，需要进行症状管理、家庭参与、预先护理计划和组织支持。本研究分为两个阶段，旨在结合多学科观点，建立小组共识，并确定制定 LTC 临终关怀策略所需的干预措施。
采用共识建立方法，分为两个阶段。第一阶段采用改良 Delphi 问卷调查，以解决和转化不同意见，达成小组共识。第二阶段探索和确定制定 LTC 临终关怀策略所需的干预措施。德尔菲问卷调查的制定是基于发表的关于医生对 LTC 最佳临终关怀的障碍和促进因素的观点、LTC 姑息治疗模式的文献检索以及发表的患者、家庭和护理人员对长期护理临终关怀的观点。第二阶段涉及 World Café 风格的研讨会讨论。一个包括医生、工作人员、管理人员、居民、家属和姑息治疗内容专家以及老年病学和老年学研究人员在内的多学科目的抽样个体参与了改良 Delphi 问卷的第一轮。从第一轮参与者中抽取的第二个目的抽样完成了第二轮改良 Delphi 问卷。然后，从 Delphi 小组中抽取第三个目的抽样，确定制定 LTC 临终关怀策略所需的优先事项。
在第一轮改良 Delphi 问卷调查中，19 名参与者对 75 项陈述进行了 9 分李克特量表评分。11 名参与者（参与率为 58%）完成了第二轮改良 Delphi 问卷调查，并就纳入 71 项候选陈述达成共识。35 名多学科参与者讨论了剩余的 71 项陈述，并确定了制定 LTC 临终关怀策略所需的首要临床实践、沟通和政策干预措施。
多学科利益相关者确定并确定了制定 LTC 临终关怀 5 点支持策略所需的干预措施的优先级。
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