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将以患者为中心的结局测量指标纳入到对患有危及生命疾病的儿童和青少年的常规护理中,预期会有哪些获益、风险、障碍和促进因素?一项针对主要利益相关者的定性访谈研究。

What are the anticipated benefits, risks, barriers and facilitators to implementing person-centred outcome measures into routine care for children and young people with life-limiting and life-threatening conditions? A qualitative interview study with key stakeholders.

机构信息

King's College London, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, London, UK.

Royal Marsden NHS Foundation Trust, London, UK.

出版信息

Palliat Med. 2024 Apr;38(4):471-484. doi: 10.1177/02692163241234797. Epub 2024 Mar 13.

Abstract

BACKGROUND

There is a growing evidence-base underpinning implementation of person-centred outcome measures into adult palliative care. However evidence on how best to achieve this with children facing life-threatening and life-limiting conditions is limited.

AIM

To identify the anticipated benefits, risks, barriers and facilitators to implementing person-centred outcome measures for children with life-limiting and life-threatening conditions.

DESIGN

Cross-sectional qualitative semi-structured interview study with key stakeholders analysed using Framework analysis informed by the adapted-Consolidated Framework for Implementation Research.

SETTING/PARTICIPANTS: A total of  = 26 children with life-limiting or life-threatening conditions,  = 40 parents/carers,  = 13 siblings and  = 15 health and social care professionals recruited from six hospitals and three children's hospices and  = 12 Commissioners of health services.

RESULTS

All participants were supportive of future implementation of person-centred outcome measures into care. Anticipated benefits included: better understanding of patient and family priorities, improved communication and collaborative working between professionals and families and standardisation in data collection and reporting. Anticipated risks included increased workload for staff and measures not being used as intended. Implementation barriers included: acceptability and usability of outcome measures by children; burden and capacity of parents/carers regarding completion; privacy concerns; and language barriers. Implementation facilitators included designing measures using language that is meaningful to children and families, ensuring potential benefits of person-centred outcome measures are communicated to encourage 'buy-in' and administering measures with known and trusted professional.

CONCLUSIONS

Implementation of person-centred outcome measures offer potential benefits for children with life-limiting and life-threatening conditions. Eight recommendations are made to maximise benefits and minimise risks in implementation.

摘要

背景

越来越多的证据支持在成人姑息治疗中实施以患者为中心的结局测量,但对于如何最好地实现这一目标,面临危及生命和生命有限条件的儿童的证据有限。

目的

确定实施以患者为中心的结局测量对患有危及生命和生命有限的儿童的预期收益、风险、障碍和促进因素。

设计

对利益相关者进行横断面定性半结构式访谈研究,使用框架分析进行分析,该分析由适应实施研究的综合框架提供信息。

设置/参与者:共有 26 名患有生命有限或生命有限的儿童、40 名父母/照顾者、13 名兄弟姐妹和 15 名卫生和社会保健专业人员,从六家医院和三家儿童临终关怀院招募,并从 12 名卫生服务专员招募。

结果

所有参与者都支持未来将以患者为中心的结局测量纳入护理。预期的好处包括:更好地了解患者和家庭的优先事项,改善专业人员和家庭之间的沟通和协作工作,以及数据收集和报告的标准化。预期的风险包括员工工作量增加和措施未按预期使用。实施障碍包括:儿童对结局测量的可接受性和可用性;父母/照顾者完成的负担和能力;隐私问题;以及语言障碍。实施促进因素包括使用对儿童和家庭有意义的语言设计措施,确保向利益相关者传达以患者为中心的结局测量的潜在收益以鼓励“投入”,并由已知和受信任的专业人员管理措施。

结论

实施以患者为中心的结局测量为患有生命有限和生命有限的儿童提供了潜在的收益。提出了八项建议,以最大限度地提高实施的收益并最小化风险。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ae54/11025304/bd73087a25b3/10.1177_02692163241234797-fig1.jpg

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