School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
Health Soc Care Community. 2022 Nov;30(6):e4165-e4174. doi: 10.1111/hsc.13810. Epub 2022 Apr 11.
Within the context of an ageing population and the added challenges posed by COVID-19, the need to optimise palliative care management in the community - the setting where a significant proportion of people prefer to die - cannot be underestimated. To date, there has been a dearth of research exploring community palliative care delivery during the pandemic. This study aimed to explore the impact of and response to COVID-19 for hospice community services in Aotearoa/New Zealand. Eighteen structured interviews were conducted (10 February-18 August 2021) with healthcare professionals from sixteen purposively sampled community hospices from New Zealand regions according to the number of COVID-19-positive patients per 100,000 inhabitants (low, medium and high) with oversampling of high prevalence areas. Two overarching themes emerged 'challenges' and 'adaptations'. Each theme had several subthemes related to service delivery in communication, visiting, allied health team collaboration and volunteer services. Adaptations involved adjusting official health advice to the local context, increased use of telehealth, reducing infection risk during in-home visits through triaging of cases, division of the workforce into teams and repurposing volunteers' services. Despite these adaptations, challenges remained, including increased workload pressures for staff and an absence of the human touch for patients and families. Implications for hospice practice and recommendations for future research are discussed. Governments must acknowledge the essential contribution of hospice to the COVID-19 pandemic and ensure that these services are incorporated into the healthcare system response.
在人口老龄化和 COVID-19 带来的额外挑战背景下，优化社区中的姑息治疗管理至关重要，因为很大一部分人希望在社区中离世。迄今为止，针对大流行期间社区姑息治疗服务的研究还很少。本研究旨在探索 COVID-19 对新西兰奥塔哥/新西社区临终关怀服务的影响和应对措施。2021 年 2 月 10 日至 8 月 18 日期间，对来自新西兰 16 个社区临终关怀机构的 18 名医疗保健专业人员进行了 18 次结构访谈，这些机构是根据每 10 万居民中 COVID-19 阳性患者的数量（低、中、高）进行了有针对性的抽样，对高流行地区进行了超额抽样。出现了两个总体主题：“挑战”和“适应”。每个主题都有几个与沟通、探访、联合医疗团队合作和志愿者服务相关的子主题。适应措施包括根据当地情况调整官方健康建议、增加远程医疗的使用、通过病例分诊降低上门探访中的感染风险、将员工分成团队以及重新调整志愿者的服务。尽管做出了这些调整，但仍存在挑战，包括员工的工作量增加和患者及家属缺少人性化关怀。文章讨论了临终关怀实践的影响和对未来研究的建议。政府必须承认临终关怀在 COVID-19 大流行中的重要贡献，并确保这些服务纳入医疗系统的应对措施中。
