Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute (APH), Van der Boechorststraat 7, 1081BT, Amsterdam, Netherlands.
Netherlands Institute for Health Services Research (Nivel), Utrecht, Netherlands.
BMC Palliat Care. 2022 Jun 23;21(1):112. doi: 10.1186/s12904-022-01000-8.
Palliative care for persons experiencing homelessness who reside in social service facilities is often late or lacking. A threefold intervention was implemented to improve palliative care for this population by increasing knowledge and collaboration between social service and palliative care professionals. This consultation service comprised: 1) consultations between social service professionals and palliative care professionals; 2) multidisciplinary meetings involving these professionals; and 3) training of these professionals. This study aims to evaluate the perceived added value of this threefold consultation service in three regions in the Netherlands.
A mixed-methods evaluation study using structured questionnaires for consultants, requesting consultants, and attendees of multidisciplinary meetings, semi-structured group and individual interviews with social service and palliative care professionals involved, weekly diaries filled out by consultants, and an implementation diary. Qualitative data were analyzed following the principles of thematic analysis. Quantitative data were analyzed descriptively.
Thirty-four consultations, 22 multidisciplinary meetings and 9 training sessions were studied during the implementation period of 21 months. Social service professionals made up the majority of all professionals reached by the intervention. In all regions the intervention was perceived to have added value for collaboration and networks of social service and palliative care professionals (connecting disciplines reciprocally and strengthening collaborations), the competences of especially social service professionals involved (competency in palliative care provision, feeling emotionally supported in complex situations), and the quality and timing of palliative care (more focus on quality of life and dying, advance care planning and looking ahead, and greater awareness of death and palliative care).
The threefold consultation service particularly helps social service professionals connect with palliative care professionals. It helps them to identify palliative care needs in good time and to provide qualitatively better palliative care to persons experiencing homelessness.
在社会服务机构中居住的无家可归者的姑息治疗往往很晚或缺乏。实施了三重干预措施，通过增加社会服务和姑息治疗专业人员之间的知识和协作，来改善这一人群的姑息治疗。该咨询服务包括：1）社会服务专业人员与姑息治疗专业人员之间的咨询；2）涉及这些专业人员的多学科会议；3）这些专业人员的培训。本研究旨在评估在荷兰的三个地区，这种三重咨询服务的感知附加值。
使用针对顾问、请求顾问和多学科会议参与者的结构化问卷，对顾问、请求顾问和多学科会议参与者进行了混合方法评估研究，对参与的社会服务和姑息治疗专业人员进行了半结构化小组和个人访谈，顾问填写了每周日记，以及实施日记。对定性数据进行了主题分析原则的分析。对定量数据进行了描述性分析。
在 21 个月的实施期间，共进行了 34 次咨询、22 次多学科会议和 9 次培训课程。社会服务专业人员构成了所有参与干预措施的专业人员中的大多数。在所有地区，该干预措施都被认为对社会服务和姑息治疗专业人员的合作和网络具有附加值（相互联系学科并加强合作）、特别参与的社会服务专业人员的能力（提供姑息治疗的能力、在复杂情况下感到情感支持）以及姑息治疗的质量和时间安排（更加关注生活质量和临终、提前护理计划和展望未来、以及对死亡和姑息治疗的认识提高）。
三重咨询服务特别有助于社会服务专业人员与姑息治疗专业人员建立联系。它有助于他们及时发现姑息治疗需求，并为无家可归者提供质量更高的姑息治疗。
