姑息治疗提供的结构和过程：泰国公立医院的全国性研究。

Structure and process of palliative care provision: a nationwide study of public hospitals in Thailand.

机构信息

Department of Society and Health, Faculty of Social Sciences and Humanities, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, 73170, Thailand.

Siriraj Palliative Care Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkoknoi, Bangkok, 10700, Thailand.

出版信息

BMC Health Serv Res. 2021 Jun 29;21(1):616. doi: 10.1186/s12913-021-06623-w.

DOI:10.1186/s12913-021-06623-w

PMID:34183000

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8240380/

Abstract

BACKGROUND

The demand for palliative care in hospitals in Thailand has rapidly increased in recent years. Subsequently, the way in which palliative care systems should be arranged to facilitate the care process and patient preparation for their end stage of life is still an ongoing debate among policy makers and researchers. Although palliative care is provided in most facilities, there is no clear protocol for palliative care due to a lack of empirical evidence. Thus, this study attempts to analyse the situation and quality of palliative care provision in Thai public hospitals.

METHODS

A cross-sectional study was conducted in 2018. A questionnaire with measures concerning hospital characteristics, the structure of palliative care provision, and processes related to achieving a good death was developed. The questionnaire was sent to all 862 public hospitals across 76 provinces, and the response rate was 62.88%. A structural equation model was specified to operationalize Donabedian's framework. To our knowledge, this is the first nationwide study to investigate facility-level palliative care provision in Thailand.

RESULTS

The study results confirmed the relationships between the structure and process of palliative care provision in hospitals. The sufficiency and competency of doctors and nurses and the variety of relaxation equipment were either directly or indirectly associated with the process components relevant to the response to the patient's needs, effective communication, and respect for the patient's dignity. In addition, the performance of palliative care research in hospitals was associated with the response to the patient's needs and effective communication, while the allocation of physical areas was associated with effective communication.

CONCLUSION

This model can be used to evaluate the overall situation of palliative care provision at the national level. It could also contribute to the development of standard measurements for evidence-based palliative care quality improvement in hospitals.

摘要

背景

近年来，泰国医院对姑息治疗的需求迅速增加。因此，政策制定者和研究人员仍在争论应如何安排姑息治疗系统，以方便护理过程和患者为生命末期做准备。尽管大多数医疗机构都提供姑息治疗，但由于缺乏经验证据，因此没有明确的姑息治疗方案。因此，本研究试图分析泰国公立医院姑息治疗的提供情况和质量。

方法

本研究于 2018 年进行了横断面研究。设计了一份问卷，其中包括有关医院特征、姑息治疗提供结构以及实现善终相关过程的措施。问卷发送给了 76 个府的 862 家公立医院，回复率为 62.88%。指定了结构方程模型来操作 Donabedian 的框架。据我们所知，这是首次在全国范围内调查泰国医疗机构姑息治疗的提供情况。