Department of Primary Care and Population Health, Centre for Ageing Population Studies, Royal Free Campus, University College London, London, UK.
Marie Curie Palliative Care Research Department, University College London, London, UK.
Health Expect. 2024 Feb;27(1):e13922. doi: 10.1111/hex.13922. Epub 2023 Nov 27.
Acute hospital wards can be difficult places for many people living with dementia. Promoting comfort and wellbeing can be challenging in this environment. There is little evidence-based support for professionals working on acute care wards on how to respond to distress and maximise comfort and wellbeing among patients living with dementia.
Our overall aim was to codesign an evidence-based easy-to-use heuristic decision-support framework, which was acceptable and practical but acknowledges the complex and acute nature of caring for patients with dementia in the hospital. This paper presents the development process and resulting framework.
A codesign study was informed by data from (1) a literature review of the care and management of people living with dementia in acute hospitals; (2) a cohort study of comfort and discomfort in people with dementia in acute hospitals; and (3) interviews with family carers and health care professionals. We synthesised evidence from these data sources and presented to key stakeholders through codesign meetings and workshops to produce our decision-support framework.
The framework consists of a series of flowcharts and operates using a three-stage process of: (1) assess comfort/discomfort; (2) consider causes of discomfort; and (3) address patient needs to manage the discomfort.
Working with key stakeholders, synthesising diverse quantitative and qualitative evidence to build a clinical framework is a feasible approach to help address the needs of patients living with dementia in an acute hospital setting. The result is a framework which is now ready for evaluation and implementation.
We worked closely with people living with dementia and family carers throughout this study, including the development of the study protocol with input on study development and design, through to inclusion in stakeholder workshops and codesign of the decision support framework.
对于许多患有痴呆症的人来说，急性医院病房可能是一个困难的地方。在这种环境下，促进舒适和幸福感可能具有挑战性。在急性护理病房工作的专业人员几乎没有基于证据的支持，无法应对患者的痛苦，最大限度地提高痴呆症患者的舒适度和幸福感。
我们的总体目标是共同设计一个基于证据的易于使用的启发式决策支持框架，该框架既可以被接受，又具有实际意义，但同时也承认在医院照顾痴呆症患者的复杂性和紧迫性。本文介绍了开发过程和由此产生的框架。
一项共同设计研究以（1）对急性医院中患有痴呆症的人的护理和管理的文献综述；（2）对急性医院中痴呆症患者的舒适和不适的队列研究；以及（3）对家庭护理者和医疗保健专业人员的访谈的数据为依据。我们综合了这些数据源的证据，并通过共同设计会议和研讨会向主要利益相关者展示，以生成我们的决策支持框架。
该框架由一系列流程图组成，使用三阶段过程进行操作：（1）评估舒适度/不舒适度；（2）考虑不适的原因；（3）满足患者需求以缓解不适。
与主要利益相关者合作，综合各种定量和定性证据来构建临床框架是一种可行的方法，可以帮助满足急性医院环境中患有痴呆症的患者的需求。该框架现已准备好进行评估和实施。
在整个研究过程中，我们与患有痴呆症的人和他们的家庭护理者密切合作，包括共同制定研究方案，对研究的发展和设计提供意见，参与利益相关者研讨会，并共同设计决策支持框架。
