School of Educational Psychology and Counselling, Faculty of Education, Monash University, Melbourne, VIC, Australia.
WA Cancer Prevention Research Unit, School of Population Health, Faculty of Health Sciences, Curtin University, Perth, WA, Australia.
J Appl Gerontol. 2023 Dec;42(12):2304-2312. doi: 10.1177/07334648231198973. Epub 2023 Sep 20.
End-of-life Goals of Care (GoC) discussions aim to support care that is consistent with patients' preferences and values. This study uses an exploratory qualitative design drawing upon a social constructivist epistemology to examine family carers' perspectives on GoC within acute Australian hospital settings. Twenty-five family carers of aging inpatients were recruited from six Australian hospitals to participate in recorded, semi-structured interviews. Data were transcribed and analyzed using reflexive thematic analysis. Three main themes were developed. Theme 1 explored carers' experiences of GoC discussions-identifying varying levels of preparedness and carers' hopes for open, two-way discussions initiated by empathic Health Care Professionals (HCPs). Theme 2 examined carers' unmet needs for time, space, consistency, and support to make careful decisions. Theme 3 identified carers advocating for patients' needs when they could not do it themselves. Preparing carers and normalizing GoC discussions relating to end-of-life care maximizes benefits for patients, carers, and HCPs involved.
生命末期目标关怀（GoC）讨论旨在支持符合患者偏好和价值观的护理。本研究采用探索性定性设计，基于社会建构主义认识论，考察了急性澳大利亚医院环境中家庭护理人员对 GoC 的看法。从六家澳大利亚医院招募了 25 名老年住院患者的家庭护理人员，以参与记录的半结构化访谈。使用反思性主题分析对数据进行转录和分析。制定了三个主要主题。主题 1 探讨了照顾者对 GoC 讨论的体验——确定了不同程度的准备程度，以及照顾者对富有同情心的医疗保健专业人员（HCP）发起的开放、双向讨论的希望。主题 2 探讨了照顾者在做出谨慎决策时对时间、空间、一致性和支持的未满足需求。主题 3 确定了当患者自己无法表达需求时，照顾者为患者的需求发声。为护理人员做好准备并使与生命末期护理相关的 GoC 讨论规范化，可使患者、护理人员和参与其中的医疗保健专业人员最大程度地受益。
