Department of General Practice and Family Medicine, Philipps-University of Marburg, Karl-von-Frisch-Straße 4, 35032, Marburg, Germany.
Professional Association of Specialised Palliative Homecare in Hesse, Weihergasse 15, 65203, Wiesbaden, Germany.
BMC Palliat Care. 2022 May 2;21(1):60. doi: 10.1186/s12904-022-00944-1.
The use of patient-reported outcome measures (PROM) and caregiver-reported outcome measures can raise the patient centeredness of treatment and improve the quality of palliative care. Nevertheless, the everyday implementation of self-report in patients and caregivers is complex, and should be adapted for use in specific settings. We aimed to implement a set of outcome measures that included patient and caregiver self- and proxy-reported outcome measures in specialised outpatient palliative care (SOPC). In this study, we explore how the Integrated Palliative Outcome Scale (IPOS), IPOS Views on Care (IPOS VoC) and the Short-form Zarit Caregiver Burden Interview (ZBI-7) can be feasibly, acceptably and appropriately implemented in the daily care routines of SOPC.
Five SOPC teams were trained, and used the outcome measures in daily practice. Team members were mainly nurses and physicians. To investigate their feedback, we used a multi-method qualitative design consisting of focus groups with SOPC-team members (n = 14), field notes of meetings and conversations with the SOPC teams. In an iterative process, we analysed the findings using qualitative content analysis and refined use of the outcome measures.
We found that integrating patient and caregiver outcome measures into daily care routines in SOPC is feasible. To improve feasibility, acceptability and appropriateness, the resulting burden on patients and relatives should be kept to a minimum, the usefulness of the measures must be understood, they should be used considerately, and administration must be manageable. We removed ZBI-7 from the set of measures as a result of feedback on its content and wording.
SOPC-team members have reservations about the implementation of PROM in SOPC, but with appropriate adjustments, its application in daily care is feasible, accepted and perceived as appropriate. Previous to use, SOPC-team members should be trained in how to apply the measures, in the design of manageable processes that include integration into electronic documentation systems, and in ongoing evaluation and support. They should also be taught how useful the measures can be.
May 19, 2017, German Clinical Trials Register DRKS-ID: DRKS00012421 .
使用患者报告结局测量（PROM）和照料者报告结局测量可以提高治疗的以患者为中心程度，并改善姑息治疗的质量。然而，在患者和照料者中日常实施自我报告是复杂的，并且应该针对特定环境进行调整。我们的目的是实施一套结局测量，包括专门的姑息治疗门诊（SOPC）中的患者和照料者自我报告以及代理报告结局测量。在本研究中，我们探讨了综合姑息治疗结局量表（IPOS）、IPOS 对护理的看法（IPOS VoC）和简短 Zarit 照料者负担访谈（ZBI-7）如何在 SOPC 的日常护理中可行、可接受和适当实施。
对五支 SOPC 团队进行了培训，并在日常实践中使用结局测量。团队成员主要是护士和医生。为了调查他们的反馈，我们使用了一种多方法定性设计，包括 SOPC 团队成员的焦点小组（n=14）、会议的现场记录和与 SOPC 团队的对话。在迭代过程中，我们使用定性内容分析对发现进行分析，并对结局测量的使用进行了改进。
我们发现，将患者和照料者结局测量纳入 SOPC 的日常护理是可行的。为了提高可行性、可接受性和适当性，应尽量减轻患者和亲属的负担，必须理解这些措施的有用性，必须谨慎使用，并且管理必须是可管理的。根据对 ZBI-7 的内容和措辞的反馈，我们将其从测量工具集中删除。
SOPC 团队成员对在 SOPC 中实施 PROM 持保留态度，但通过适当调整，其在日常护理中的应用是可行的、可接受的，并且被认为是适当的。在使用之前，应培训 SOPC 团队成员如何应用这些措施，设计可管理的流程，包括将其纳入电子文档系统，并进行持续评估和支持。还应教导他们这些措施的有用性。
2017 年 5 月 19 日，德国临床试验注册处 DRKS-ID：DRKS00012421。
