针对居住在养老院的晚期痴呆症患者的家庭护理决策支持干预措施：一项国际预先护理计划干预研究方案（mySupport 研究）。
A family carer decision support intervention for people with advanced dementia residing in a nursing home: a study protocol for an international advance care planning intervention (mySupport study).
机构信息
Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK.
School of Nursing and Midwifery, Queens University Belfast, Belfast, UK.
出版信息
BMC Geriatr. 2022 Oct 26;22(1):822. doi: 10.1186/s12877-022-03533-2.
BACKGROUND
Where it has been determined that a resident in a nursing home living with dementia loses decisional capacity, nursing home staff must deliver care that is in the person's best interests. Ideally, decisions should be made involving those close to the person, typically a family carer and health and social care providers. The aim of the Family Carer Decisional Support intervention is to inform family carers on end-of-life care options for a person living with advanced dementia and enable them to contribute to advance care planning. This implementation study proposes to; 1) adopt and apply the intervention internationally; and, 2) train nursing home staff to deliver the family carer decision support intervention.
METHODS
This study will employ a multiple case study design to allow an understanding of the implementation process and to identify the factors which determine how well the intervention will work as intended. We will enrol nursing homes from each country (Canada n = 2 Republic of Ireland = 2, three regions in the UK n = 2 each, The Netherlands n = 2, Italy n = 2 and the Czech Republic n = 2) to reflect the range of characteristics in each national and local context. The RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework will guide the evaluation of implementation of the training and information resources. Our mixed methods study design has three phases to (1) establish knowledge about the context of implementation, (2) participant baseline information and measures and (3) follow up evaluation.
DISCUSSION
The use of a multiple case study design will enable evaluation of the intervention in different national, regional, cultural, clinical, social and organisational contexts, and we anticipate collecting rich and in-depth data. While it is hoped that the intervention resources will impact on policy and practice in the nursing homes that are recruited to the study, the development of implementation guidelines will ensure impact on wider national policy and practice. It is our aim that the resources will be sustainable beyond the duration of the study and this will enable the resources to have a longstanding relevance for future advance care planning practice for staff, family carers and residents with advanced dementia.
背景
当养老院中患有痴呆症的居民失去决策能力时，养老院的工作人员必须提供符合患者最佳利益的护理。理想情况下，应让与患者关系密切的人做出决策，通常是家庭护理人员以及医疗和社会保健提供者。家庭护理人员决策支持干预的目的是向患有晚期痴呆症的家庭护理人员介绍有关临终关怀选择，并使他们能够参与提前护理计划。本实施研究旨在：1）在国际上采用和应用该干预措施；2）培训养老院工作人员提供家庭护理人员决策支持干预。
方法
本研究将采用多案例研究设计，以了解实施过程并确定影响干预效果的因素。我们将从每个国家（加拿大 n=2、爱尔兰共和国 n=2、英国三个地区 n=2 每个、荷兰 n=2、意大利 n=2 和捷克共和国 n=2）招募养老院，以反映每个国家和地方背景的范围。RE-AIM（范围、效果、采用、实施、维护）框架将指导培训和信息资源实施的评估。我们的混合方法研究设计有三个阶段：1）建立实施背景知识；2）参与者基线信息和措施；3）后续评估。
讨论
使用多案例研究设计将能够在不同的国家、地区、文化、临床、社会和组织背景下评估干预措施，我们预计将收集丰富和深入的数据。虽然我们希望干预资源会对参与研究的养老院的政策和实践产生影响，但实施指南的制定将确保对更广泛的国家政策和实践产生影响。我们的目标是使资源在研究期间之外具有可持续性，这将使资源对未来为患有晚期痴呆症的工作人员、家庭护理人员和居民提供的提前护理计划实践具有长期相关性。
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