End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium.
Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium.
Palliat Med. 2021 Dec;35(10):1961-1974. doi: 10.1177/02692163211040187. Epub 2021 Aug 22.
Palliative care is advocated for older people with frailty and multimorbidity in the community. However, how to best deliver it is unclear.
To develop and model an intervention of short-term specialized palliative care that is initiated timely based on complex care needs and integrated with primary care for older people with frailty and their family, detailing the intervention components, outcomes and preconditions needed for implementation, using a novel theoretical approach.
Observational study informed by the UK MRC guidance for complex interventions integrated with a Theory of Change (i.e. hypothetical causal pathway to impact) approach. We synthesized evidence from a systematic review, semi-structured interviews, group discussions and Theory of Change workshops.
Primary care in Flanders, Belgium.
We identified patient and family carer-related long-term outcomes and preconditions to achieve them for example, service providers are willing and able to deliver the intervention. The intervention components included implementation components, for example, training for service providers, and a core component, that is, provision of timely short-term specialized palliative care by a specialized palliative home care nurse. The latter includes: short-term service delivery; collaborative and integrative working within primary care; delivery of holistic needs- and capacity-based care; person-centred and family-focussed; and goal-oriented pro-active care.
The Theory of Change approach allowed us to identify multiple intervention components targeting different stakeholders to achieve the desired outcomes. It also facilitated a detailed description of the intervention which aims to increase replicability and effective comparisons with other interventions.
衰弱和多病共存的社区老年人提倡姑息治疗。然而，如何最好地提供姑息治疗尚不清楚。
根据复杂的护理需求，为衰弱的老年人及其家庭开发并构建一种及时启动的短期专业姑息治疗干预措施，并将其与初级保健相结合，详细说明干预措施的组成部分、结果和实施所需的前提条件，使用一种新的理论方法。
受英国 MRC 复杂干预措施指南的指导，采用理论转化（即对影响的假设因果途径）方法进行的观察性研究。我们综合了系统评价、半结构化访谈、小组讨论和理论转化研讨会的证据。
比利时佛兰德斯的初级保健。
我们确定了与患者和家庭照顾者相关的长期结果以及实现这些结果的前提条件，例如，服务提供者愿意并有能力提供干预措施。干预措施的组成部分包括实施组件，例如，为服务提供者提供培训，以及核心组件，即由专业姑息家庭护理护士提供及时的短期专业姑息治疗。后者包括：短期服务提供；初级保健内部的协作和整合工作；提供基于需求和能力的整体护理；以患者为中心和以家庭为重点；以及以目标为导向的主动护理。
理论转化方法使我们能够确定针对不同利益相关者的多个干预措施组件，以实现预期的结果。它还便于详细描述干预措施，旨在提高可复制性，并与其他干预措施进行有效比较。
