School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland.
School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland.
Eval Rev. 2023 Oct;47(5):820-870. doi: 10.1177/0193841X231162402. Epub 2023 Apr 4.
Breathlessness support services have demonstrated benefits for breathlessness mastery, quality of life and psychosocial outcomes for people living with breathlessness. However, these services have predominantly been implemented in hospital and home care contexts. This study aims to evaluate the adaptation and implementation of a hospice-based outpatient Multidisciplinary Breathlessness Support Service (MBSS) in Ireland. A sequential explanatory mixed methods design guided this study. People with chronic breathlessness participated in longitudinal questionnaires ( = 10), medical record audit ( = 14) and a post-discharge interview ( = 8). Caregivers ( = 1) and healthcare professionals involved in referral to ( = 2) and delivery of ( = 3) the MBSS participated in a cross-sectional interview. Quantitative and qualitative data were integrated deductively via the pillar integration process, guided by the RE-AIM framework. Integration of mixed methods data enhanced understanding of factors influencing the reach, adoption, implementation and maintenance of the MBSS, and the potential outcomes that were most meaningful for service users. Potential threats to the sustainability of the MBSS related to potential preconceptions of hospice care, the lack of standardized discharge pathways from the service and access to primary care services to sustain pharmacological interventions. This study suggests that an adapted multidisciplinary breathlessness support intervention is feasible and acceptable in a hospice context. However, to ensure optimal reach and maintenance of the intervention, activities are required to ensure that misconceptions about the setting do not influence willingness to accept referral to MBSS services and integration of services is needed to enable consistency in referral and discharge processes.
呼吸困难支持服务已被证明对呼吸困难控制、生活质量和呼吸困难患者的心理社会结局有益。然而，这些服务主要在医院和家庭护理环境中实施。本研究旨在评估基于临终关怀的门诊多学科呼吸困难支持服务（MBSS）在爱尔兰的适应性和实施情况。一项顺序解释性混合方法设计指导了这项研究。慢性呼吸困难患者参与了纵向问卷调查（=10）、病历审核（=14）和出院后访谈（=8）。参与转诊（=2）和提供（=3）MBSS 的护理人员（=1）和医疗保健专业人员进行了横断面访谈。通过柱集成过程，根据 RE-AIM 框架，对定量和定性数据进行了演绎式整合。混合方法数据的整合增强了对影响 MBSS 的可及性、采用、实施和维持的因素以及对服务使用者最有意义的潜在结果的理解。与临终关怀护理的潜在偏见、缺乏从服务中标准化出院途径以及获得维持药物干预的初级保健服务相关的可持续性威胁。本研究表明，在临终关怀环境中，适应的多学科呼吸困难支持干预是可行且可接受的。然而，为了确保干预措施的最佳可及性和维持，需要开展活动，以确保对环境的误解不会影响接受 MBSS 服务转诊的意愿，并需要整合服务，以确保转诊和出院流程的一致性。
