Rowe Julian T, Parrillo Elaina, Stanford Olivia, Wenzel Jennifer, Johnston Fabian M
School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA.
J Palliat Med. 2024 Mar;27(3):358-366. doi: 10.1089/jpm.2022.0516. Epub 2023 Nov 20.
Palliative care is a valuable component of health care that improves a patient's quality of life, yet its availability to patients with serious chronic illness remains relatively low. Due to their knowledge of community preferences and ability to improve patient education and access to care, community health workers (CHWs) can increase palliative care usage by patients. Notably, barriers to CHWs helping patients with serious chronic illness remain poorly understood. Explore the perception of barriers CHWs feel they face when attempting to support the health care of patients with serious chronic illness. Qualitative semistructured individual interviews of CHWs and qualitative descriptive analysis. Twelve CHWs who have worked with patients with serious chronic illness were recruited from the Johns Hopkins Healthcare LLC and the Baltimore Alliance for Careers in Healthcare organizations to virtually participate. CHWs perceived both active and passive barriers that obstructed their efforts to work with seriously ill patients. CHWs shared that these barriers were dependent on themselves, their peers, and their work environments. Prevalent themes included interprofessional conflict, poor health care worker understanding of the CHW's role, and lack of access to quality resource organizations. CHWs noted job-specific training, better means to identify needed resources for patients, and inclusive health care teams as solutions to support their professional goals, while helping patients with serious illness. There are multiple perceived barriers to CHWs helping seriously ill patients. CHWs aiding patients with serious illness can be supported through better job training, better resource management tools, and improved communication between health care team members.
姑息治疗是医疗保健的重要组成部分，可提高患者的生活质量，然而，患有严重慢性病的患者获得姑息治疗的机会仍然相对较低。由于社区卫生工作者（CHWs）了解社区偏好，且有能力改善患者教育和获得医疗服务的机会，他们可以增加患者对姑息治疗的使用。值得注意的是，对于CHWs在帮助患有严重慢性病的患者时所面临的障碍，我们仍知之甚少。探讨CHWs在试图支持患有严重慢性病的患者的医疗保健时所感受到的障碍认知。对CHWs进行定性半结构化个人访谈和定性描述分析。从约翰霍普金斯医疗有限责任公司和巴尔的摩医疗保健职业联盟组织招募了12名曾与患有严重慢性病的患者合作过的CHWs，以虚拟方式参与。CHWs意识到了阻碍他们与重症患者合作的主动和被动障碍。CHWs表示，这些障碍取决于他们自己、同行以及工作环境。普遍的主题包括跨专业冲突、医护人员对CHW角色的理解不足以及难以获得优质资源组织。CHWs指出，针对特定工作的培训、更好地为患者识别所需资源的方法以及包容性的医疗团队是支持他们的职业目标同时帮助重症患者的解决方案。CHWs在帮助重症患者方面存在多种认知障碍。可以通过更好的工作培训、更好的资源管理工具以及改善医护团队成员之间的沟通来支持帮助重症患者的CHWs。
