Center for Innovation to Implementation (K.F.G., M.Y., M.D.M., J.R.G., C.G., K.A.L.), VA Palo Alto Health Care System, Menlo Park, CA, USA; Division of Primary Care and Population Health (K.F.G., K.A.L.), Stanford University School of Medicine, Stanford, CA, USA.
Center for Innovation to Implementation (K.F.G., M.Y., M.D.M., J.R.G., C.G., K.A.L.), VA Palo Alto Health Care System, Menlo Park, CA, USA; Office of Research (M.Y.), Patient Care Services, Stanford Healthcare, Stanford, CA, USA.
J Pain Symptom Manage. 2022 Oct;64(4):349-358. doi: 10.1016/j.jpainsymman.2022.06.017. Epub 2022 Jul 5.
Patient experiences should be considered by healthcare systems when implementing care practices to improve quality of end-of-life care. Families and caregivers of recent in-patient decedents may be best positioned to recommend practices for quality improvement.
To identify actionable practices that bereaved families highlight as contributing to high quality end-of-life care.
We conducted qualitative content analysis of narrative responses to the Bereaved Family Surveys Veterans Health Administration inpatient decedents. Out of 5964 completed surveys in 2017, 4604 (77%) contained at least one word in response to the open-ended questions. For feasibility, 1500/4604 responses were randomly selected for analysis. An additional 300 randomly selected responses were analyzed to confirm saturation.
Over 23% percent (355/1500) of the initially analyzed narrative responses contained actionable practices. By synthesizing narrative responses to the BFS in a national healthcare system, we identified 98 actionable practices reported by the bereaved families that have potential for implementation in QI efforts. Specifically, we identified 67 end-of-life practices and 31 practices in patient-centered care domains of physical environment, food, staffing, coordination, technology and transportation. The 67 cluster into domains including respectful care and communication, emotional and spiritual support, death benefits, symptom management. Sorting these practices by target levels for organizational change illuminated opportunities for implementation.
Narrative responses from bereaved family members can yield approaches for systematic quality improvement. These approaches can serve as a menu in diverse contexts looking for approaches to improve patient quality of death in in-patient settings.
医疗系统在实施改善临终关怀质量的护理实践时，应考虑患者体验。最近住院死亡患者的家属和护理人员可能最有资格推荐质量改进实践。
确定临终关怀质量高的丧亲家庭强调的可行实践。
我们对退伍军人健康管理局 2017 年住院死亡患者的丧亲家庭调查的叙述性回答进行了定性内容分析。在 5964 份完成的调查中，有 4604 份（77%）至少对开放式问题的回答有一个字。为了可行性，随机选择了 1500/4604 个回复进行分析。另外分析了 300 个随机选择的回复以确认饱和度。
超过 23%（355/1500）的初始分析叙述性回复包含可操作的实践。通过综合全国医疗保健系统中 BFS 的叙述性回复，我们确定了 98 项由丧亲家庭报告的可操作实践，这些实践具有在 QI 工作中实施的潜力。具体而言，我们确定了 67 项临终关怀实践和 31 项患者为中心的关怀领域的实践，包括物理环境、食物、人员配备、协调、技术和交通。这 67 项实践分为尊重护理和沟通、情感和精神支持、死亡福利、症状管理等领域。按组织变革的目标水平对这些实践进行分类，突显了实施的机会。
丧亲家庭成员的叙述性回复可以为系统质量改进提供方法。这些方法可以作为不同背景下改善住院患者死亡质量的方法菜单。
