J Gerontol Nurs. 2023 Nov;49(11):33-41. doi: 10.3928/00989134-20231011-02. Epub 2023 Nov 1.
Serious illness communication in homecare about hospice and/or palliative care transitions is lacking due to clinical culture. The purpose of the current study was to understand communication openings using COMFORT™, a palliative care communication model used to train nurses. Qualitative, focus group interviews with 31 homecare nurses were conducted. Data were transcribed verbatim and thematically analyzed using NVivo software, followed by hand-sorting. Four themes for communication openings for initiating discussions about potential hospice and/or palliative care transitions were identified: (homecare appropriateness, eligibility requirements, and staffing); (patient physical decline, psychosocial changes, safety concerns, and denying/stopping care); (caregiver physical changes and patient readiness); and (need for hospice, checking for prognosis understanding, increasing interprofessional care needs, and providing end-of-life care). This study extends the concept of communication openings in the COMFORT model. Further development of communication openings as part of COMFORT communication is needed in educational and intervention research. [(11), 33-41.].
由于临床文化的原因，家庭护理中关于临终关怀和/或姑息治疗过渡的重病沟通严重不足。本研究的目的是使用 COMFORT™（一种用于培训护士的姑息治疗沟通模型）来理解沟通切入点。对 31 名家庭护理护士进行了定性、焦点小组访谈。使用 NVivo 软件对转录的逐字数据进行主题分析，然后进行手工分类。确定了四个用于启动有关潜在临终关怀和/或姑息治疗过渡讨论的沟通切入点主题：（家庭护理的适宜性、资格要求和人员配备）；（患者身体恶化、心理社会变化、安全问题和拒绝/停止护理）；（照顾者身体变化和患者准备情况）；以及（需要临终关怀、检查预后理解、增加跨专业护理需求和提供临终关怀）。本研究扩展了 COMFORT 模型中沟通切入点的概念。需要在教育和干预研究中进一步发展 COMFORT 沟通中的沟通切入点。
