Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO, USA.
Am J Hosp Palliat Care. 2023 Dec;40(12):1371-1378. doi: 10.1177/10499091231163156. Epub 2023 Mar 12.
Early introduction of palliative care can improve patient-centered outcomes for older adults with complex medical conditions. However, identifying the need for and introducing palliative care with patients and caregivers is often difficult. We aim to identify how and why a multi-setting approach to palliative care discussions may improve the identification of palliative care needs and how to facilitate these conversations.
Descriptive qualitative study to inform the development and future pilot testing of a model to improve recognition of, and support for, unmet palliative care needs in home health care (HHC). Thematic analysis of semi-structured interviews with providers across inpatient (n = 11), primary care (n = 17), and HHC settings (n = 10).
Four key themes emerged: 1) providers across settings can identify palliative care needs using their unique perspectives of the patient's care, 2) identifying palliative care needs is challenging due to infrequent communication and lack of shared information between providers, 3) importance of identifying a clinical lead of patient care who will direct palliative care discussions (primary care provider), and 4) importance of identifying a care coordination lead (HHC) to bridge communication among multi-setting providers. These themes highlight a multi-setting approach that would improve the frequency and quality of palliative care discussions.
A lack of structured communication across settings is a major barrier to introducing and providing palliative care. A novel model that improves communication and coordination of palliative care across HHC, inpatient and primary care providers may facilitate identifying and addressing palliative care needs in medically complex older adults.
早期引入姑息治疗可以改善患有复杂医学疾病的老年人以患者为中心的结局。然而，确定患者和照护者对姑息治疗的需求并引入姑息治疗往往具有挑战性。我们旨在确定多环境姑息治疗讨论方法如何以及为何可以改善姑息治疗需求的识别，并促进这些对话。
描述性定性研究，为改善家庭保健（HHC）中未满足的姑息治疗需求的识别和支持提供模型的开发和未来试点测试提供信息。对来自住院（n=11）、初级保健（n=17）和 HHC 环境（n=10）的提供者进行半结构化访谈的主题分析。
出现了四个主要主题：1） 各环境中的提供者可以使用他们对患者护理的独特视角来识别姑息治疗需求，2） 由于提供者之间沟通不频繁且缺乏共享信息，因此确定姑息治疗需求具有挑战性，3） 确定将指导姑息治疗讨论的患者护理临床负责人（初级保健提供者）的重要性，以及 4） 确定护理协调负责人（HHC）以弥合多环境提供者之间沟通的重要性。这些主题突出了一种多环境方法，该方法可以提高姑息治疗讨论的频率和质量。
跨环境缺乏结构化沟通是引入和提供姑息治疗的主要障碍。一种新颖的模型可以改善 HHC、住院和初级保健提供者之间的姑息治疗沟通和协调，从而有助于识别和解决医学上复杂的老年人的姑息治疗需求。
