Department of Family Medicine and Geriatrics, 12223Keck School of Medicine of the University of Southern California, Alhambra, CA, USA.
Leonard Davis School of Gerontology, 5116University of Southern California, Los Angeles, CA, USA.
Am J Hosp Palliat Care. 2023 Feb;40(2):122-128. doi: 10.1177/10499091221090498. Epub 2022 May 15.
Home-based palliative care (HBPC) programs are proliferating across the U.S, yet face significant, documented challenges in promoting uptake of services and sustaining sufficient patient referrals. There is a huge need to understand effective methods for engaging physicians, patients, and caregivers in palliative care. Thus, the purpose of this study was to elicit successful practices on how to best communicate about HBPC to both healthcare providers and patients/caregivers.
Focus groups with nine California-based HBPC organizations were conducted between January and April 2020. Discussions lasted approximately 54 minutes, were guided by a semi-structured protocol, audio-recorded, and transcribed verbatim. Thematic analysis was used to identify themes and codes from the data.
Twenty-five interdisciplinary HBPC staff members participated in a focus group. Most identified as white (76%), female (76%), and working in their current position for 5 years or less (56%). Three themes were identified from the data: (1) value of relationships; (2) communication do's and don'ts; and (3) need for education. Participants discussed actionable recommendations for each theme.
Study findings highlight several successful practices for HBPC programs to communicate- and foster relationships with healthcare professionals and patients/families about palliative care, with education at the crux. Lessons learned about key words and phrases to say and to avoid are particularly valuable for budding HBPC programs. Our results suggest that HBPC providers exert enormous efforts to increase patient referrals and enrollment through strategic, continuous outreach and education to physicians, patients, and their caregivers; however, palliative care educational interventions are needed.
美国家庭姑息治疗（HBPC）项目正在全美范围内迅速发展，但在推广服务和维持足够的患者转介方面面临着重大的、有记录的挑战。因此，了解有效方法来让医生、患者和护理人员参与姑息治疗是非常必要的。因此，本研究的目的是探讨如何最好地向医疗保健提供者和患者/护理人员传达 HBPC 的成功实践。
2020 年 1 月至 4 月期间，对加利福尼亚州的 9 个 HBPC 组织进行了焦点小组讨论。讨论持续了大约 54 分钟，由半结构化方案指导，进行了音频录制，并逐字转录。采用主题分析法从数据中识别主题和代码。
25 名跨学科 HBPC 工作人员参加了焦点小组讨论。大多数人（76%）是白人，女性（76%），在当前职位上工作了 5 年或更短时间（56%）。从数据中确定了三个主题：（1）关系的价值；（2）沟通的注意事项；（3）教育需求。参与者讨论了每个主题的可操作建议。
研究结果突出了 HBPC 项目在与医疗保健专业人员和患者/家庭就姑息治疗进行沟通和建立关系方面的几种成功做法，教育是关键。关于要说和避免的关键词和短语的经验教训对于新兴的 HBPC 项目尤其有价值。我们的研究结果表明，HBPC 提供者通过对医生、患者及其护理人员进行战略性的、持续的外联和教育，努力增加患者的转介和参与；然而，姑息治疗教育干预是必要的。
