对于面临经济困难和贫困的人来说，在家中离世：健康与社会护理专业人员如何识别并思考患者的情况。
Dying at home for people experiencing financial hardship and deprivation: How health and social care professionals recognise and reflect on patients' circumstances.
作者信息
Quinn Sam, Richards Naomi, Gott Merryn
机构信息
End of Life Studies Group, School of Interdisciplinary Studies, Dumfries Campus, University of Glasgow, Dumfries DG1 4ZL, UK.
End of Life Studies Group, School of Interdisciplinary Studies, Dumfries Campus, University of Glasgow, Dumfries, UK.
出版信息
Palliat Care Soc Pract. 2023 Mar 31;17:26323524231164162. doi: 10.1177/26323524231164162. eCollection 2023.
BACKGROUND
International palliative care policy often views home as the most desirable location for end-of-life care. However, people living in more deprived areas can worry about dying in poor material circumstances and report more benefits from hospital admission at the end of life. There is increasing recognition of inequities in the experience of palliative care, particularly for people living in more deprived areas. Promoting an equity agenda in palliative care means building healthcare professionals' capacity to respond to the social determinants of health when working with patients near the end of their life.
OBJECTIVES
The purpose of this article is to present data which reveal how some health and social care professionals view home dying for people experiencing financial hardship and deprivation.
DESIGN
This work was framed by social constructionist epistemology.
METHODS
Semi-structured qualitative interviews ( = 12) were conducted with health and social care professionals who support people at the end of life. Participants were recruited from one rural and one urban health board area in Scotland, UK. Data collection occurred between February and October 2021.
ANALYSIS
Thematic analysis was used to analyse the interview data.
DISCUSSION
Our findings suggest that healthcare staff relied on physical clues in the home environment to identify if people were experiencing financial hardship, found discussions around poverty challenging and lacked awareness of how inequities intersect at the end of life. Health professionals undertook 'placing' work to try and make the home environment a suitable space for dying, but some barriers were seen as insurmountable. There was recognition that increased partnership working and education could improve patient experiences. We argue further research is needed to capture the perspectives of individuals with direct lived experience of end-of-life care and financial hardship.
背景
国际姑息治疗政策通常认为家是临终关怀最理想的场所。然而，生活在贫困地区的人们可能会担心在物质条件差的环境中离世，并表示临终时住院会带来更多益处。人们越来越认识到姑息治疗体验中的不平等现象，尤其是对于生活在更贫困地区的人。在姑息治疗中推动公平议程意味着培养医疗保健专业人员在为临终患者提供服务时应对健康的社会决定因素的能力。
目的
本文旨在呈现数据，揭示一些卫生和社会护理专业人员如何看待贫困和匮乏人群在家中离世的情况。
设计
这项工作以社会建构主义认识论为框架。
方法
对为临终患者提供支持的卫生和社会护理专业人员进行了半结构化定性访谈（n = 12）。参与者从英国苏格兰的一个农村和一个城市卫生委员会地区招募。数据收集于2021年2月至10月期间进行。
分析
采用主题分析法对访谈数据进行分析。
讨论
我们的研究结果表明，医护人员依靠家庭环境中的实际线索来确定人们是否处于经济困难之中，发现围绕贫困的讨论具有挑战性，并且缺乏对不平等在临终时如何相互交织的认识。卫生专业人员进行了“布置”工作，试图使家庭环境成为适合离世的空间，但有些障碍被视为无法逾越。人们认识到加强合作和教育可以改善患者体验。我们认为需要进一步研究以了解有临终关怀和经济困难直接生活经历的个人的观点。
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