Department of Public Health and Primary Care, Ghent University, Gent, Belgium; Vrije Universiteit Brussel, Brussel, Belgium; End-of-Life Care Research Group, Ghent University, Gent & Vrije Universiteit Brussel, Brussel, Belgium.
Department of Public Health and Primary Care, Ghent University, Gent, Belgium.
Ann Palliat Med. 2022 Sep;11(9):2830-2843. doi: 10.21037/apm-22-146. Epub 2022 Aug 18.
Palliative patients often suffer from serious illness and commonly move between care settings. As such, transfers of patients can take place between acute hospital based care and community based care in both directions. The involvement of multiple caregivers providing care across settings causes fragmentation of care. To address this challenge and to optimize coordination and continuity of care, we explored experiences of palliative patients regarding their transfers between care settings and the perceived role of the treating family physician.
Qualitative interview study of 20 palliative patients. Participating settings were the hospital and hospitals' palliative care unit, the nursing home, the home care setting and the palliative day care centre. A constant comparative method was used to analyze data.
Although the home was considered the preferred residence, perceptions of unsafety arose in cases of increased symptom burden and when the organization of home care was insufficiently geared to the patients' needs. Both the nursing home and the palliative care unit offered safety and good care when home residence became unfeasible. Upon hospital admission, experiences did not always meet expectations, varying significantly depending on the hospital, type of ward and reason for hospitalization. Perceived issues regarding hospital discharge were premature release, lack of seamless care and home care insufficiently tailored to the patients' needs. The family physician's role assignment ranged from pivotal to minimal. Patients especially expected their family physician to guarantee continuity of care.
Home is considered the preferred place of long-term care, as long as it is perceived a safe environment. A person-centered approach, focusing on the patient's complex needs, is not consistently implemented in palliative care settings. Barriers in inter-professional collaboration need to be tackled to provide high quality care across settings.
姑息治疗患者常患有严重疾病，并经常在不同的医疗环境中转移。因此，患者的转移可以在急性医院基础护理和社区基础护理之间双向进行。多个护理人员在不同环境中提供护理会导致护理的碎片化。为了解决这一挑战，优化姑息治疗患者的协调和连续性护理，我们探讨了姑息治疗患者在医疗环境之间转移的经历，以及他们对主治家庭医生的看法。
对 20 名姑息治疗患者进行定性访谈研究。参与的治疗环境包括医院和医院的姑息治疗病房、养老院、家庭护理环境和姑息治疗日间护理中心。采用恒定性比较方法分析数据。
尽管家庭被认为是首选的居住场所，但当症状负担增加和家庭护理的组织不能充分满足患者的需求时，家庭会被认为是不安全的。当家庭居住变得不可行时，养老院和姑息治疗病房都能提供安全和良好的护理。入院时，体验并不总是符合预期，这取决于医院、病房类型和住院原因而有很大差异。患者对出院的看法主要是过早释放、无缝护理的缺乏以及家庭护理不能满足患者的需求。家庭医生的角色分配范围从关键到最小。患者特别希望他们的家庭医生能保证护理的连续性。
只要家庭被认为是安全的环境，它就被认为是长期护理的首选场所。以患者复杂需求为中心的方法在姑息治疗环境中并没有得到一致的实施。需要解决跨专业协作中的障碍，以提供跨环境的高质量护理。
