同时令人安心和不安：一项针对老年患者社区预期用药处方的纵向定性研究。
Simultaneously reassuring and unsettling: a longitudinal qualitative study of community anticipatory medication prescribing for older patients.
机构信息
Palliative & End of Life Care Group in Cambridge (PELiCAM), Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB2 0SR, UK.
Nottingham Centre for the Advancement of Research into Supportive, Palliative and End of Life Care, School of Health Sciences, University of Nottingham, Nottingham NG8 1BB, UK.
出版信息
Age Ageing. 2022 Dec 5;51(12). doi: 10.1093/ageing/afac293.
BACKGROUND
The prescription of injectable anticipatory medications is widely accepted by clinicians to be key in facilitating effective last-days-of-life symptom control. Community end-of-life care and admission avoidance is particularly strongly advocated for older patients. However, patient and informal caregiver views and experiences of anticipatory medication have been little studied to date.
OBJECTIVE
To understand older patients', informal caregivers' and clinicians' views and experiences of the prescribing and use of anticipatory medications.
DESIGN
Qualitative study.
SETTING
Patients' homes and residential care homes.
PARTICIPANTS
Purposive sample of six older patients, nine informal caregivers and six clinicians.
METHODS
Multi-perspective, longitudinal interview study based on 11 patient cases. Semi-structured interviews (n = 28) were analysed thematically.
RESULTS
Three themes were identified: (i) living in the present whilst making plans: anticipatory medications were used by clinicians as a practical tool in planning for uncertainty, while patients and informal caregivers tried to concentrate on living in the present; (ii) anticipation of dying: it was rare for patients and informal caregivers to discuss explicitly the process and experience of dying with clinicians; and (iii) accessing timely care: the use of anticipatory medications generally helped symptom control. However, informal caregivers reported difficulties in persuading nurses to administer them to patients.
CONCLUSIONS
Anticipatory medications are simultaneously reassuring and a source of unease to older patients and their informal caregivers. Prescriptions need careful discussion and tailoring to their preferences and experience. Nurses' decisions to administer medication should consider informal caregivers' insights into patient distress, especially when patients can no longer communicate their needs.
背景
注射用预期待遇药物的处方被临床医生广泛接受，是促进有效临终症状控制的关键。社区临终关怀和避免入院尤其强烈地提倡用于老年患者。然而，迄今为止，患者和非正式照顾者对预期待遇药物的看法和经验很少被研究。
目的
了解老年患者、非正式照顾者和临床医生对预期待遇药物的处方和使用的看法和经验。
设计
定性研究。
设置
患者的家和养老院。
参与者
有目的抽取的 6 名老年患者、9 名非正式照顾者和 6 名临床医生。
方法
基于 11 个病例的多视角、纵向访谈研究。对 28 次半结构化访谈进行了主题分析。
结果
确定了三个主题：（i）活在当下的同时做计划：临床医生将预期待遇药物用作规划不确定性的实用工具，而患者和非正式照顾者则试图专注于活在当下；（ii）对死亡的预期：患者和非正式照顾者很少与临床医生明确讨论死亡的过程和经历；（iii）及时获得护理：使用预期待遇药物通常有助于控制症状。然而，非正式照顾者报告说，他们很难说服护士给患者使用这些药物。
结论
预期待遇药物同时让老年患者及其非正式照顾者感到安心和不安。处方需要仔细讨论，并根据他们的偏好和经验进行调整。护士给药的决定应考虑非正式照顾者对患者痛苦的见解，尤其是当患者无法再表达自己的需求时。
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