姑息治疗和临终关怀的质量：对加拿大魁北克省改善指标的专家建议的定性研究。
Quality of palliative and end-of-life care: a qualitative study of experts' recommendations to improve indicators in Quebec (Canada).
机构信息
Faculty of Nursing, University of Montreal, PO Box 6128, Centre-ville Station, Montréal, QC, H3C 3J7, Canada.
Centre de recherche Charles-Le Moyne (CRCLM), Campus de Longueuil - Université de Sherbrooke, 150 Place Charles LeMoyne - Bureau 200, Longueuil, QC, J4K 0A8, Canada.
出版信息
BMC Palliat Care. 2024 Jun 10;23(1):146. doi: 10.1186/s12904-024-01474-8.
BACKGROUND
In 2021, the National Institute of Public Health (INSPQ) (Quebec, Canada), published an update of the palliative and end-of-life care (PEoLC) indicators. Using these updated indicators, this qualitative study aimed to explore the point of view of PEoLC experts on how to improve access and quality of care as well as policies surrounding end-of-life care.
METHODS
Semi-directed interviews were conducted with palliative care and policy experts, who were asked to share their interpretations on the updated indicators and their recommendations to improve PEoLC. A thematic analysis method was used.
RESULTS
The results highlight two categories of interpretations and recommendations pertaining to: (1) data and indicators and (2) clinical and organizational practice. Participants highlight the lack of reliability and quality of the data and indicators used by political and clinical stakeholders in evaluating PEoLC. To improve data and indicators, they recommend: improving the rigour and quality of collected data, assessing death percentages in all healthcare settings, promoting research on quality of care, comparing data to EOL care directives, assessing use of services in EOL, and creating an observatory on PEoLC. Participants also identified barriers and disparities in accessing PEoLC as well as inconsistency in quality of care. To improve PEoLC, they recommend: early identification of palliative care patients, improving training for all healthcare professionals, optimizing professional practice, integrating interdisciplinary teams, and developing awareness on access disparities.
CONCLUSIONS
Results show that PEoLC is an important aspect of public health. Recommendations issued are relevant to improve PEoLC in and outside Quebec.
背景
2021 年，加拿大魁北克省国家公共卫生研究所（INSPQ）发布了姑息治疗和临终关怀（PEoLC）指标的更新版。本项使用这些更新指标的定性研究旨在探讨临终关怀专家如何改善临终关怀的可及性和服务质量以及相关政策的观点。
方法
对姑息治疗和政策专家进行了半结构化访谈，要求他们分享对更新指标的解释以及改善临终关怀的建议。使用了主题分析方法。
结果
结果突出了与以下两个类别的解释和建议相关的内容：（1）数据和指标；（2）临床和组织实践。参与者强调了政治和临床利益相关者在评估 PEoLC 时使用的数据和指标缺乏可靠性和质量。为了改进数据和指标，他们建议：提高收集数据的严谨性和质量，评估所有医疗保健环境中的死亡百分比，促进护理质量研究，将数据与临终关怀指令进行比较，评估临终关怀服务的使用情况，并创建一个临终关怀观察站。参与者还确定了临终关怀的可及性障碍和差距以及护理质量的不一致性。为了改善临终关怀，他们建议：早期识别姑息治疗患者，提高所有医疗保健专业人员的培训，优化专业实践，整合跨学科团队，并提高对可及性差距的认识。
结论
结果表明，PEoLC 是公共卫生的一个重要方面。提出的建议对于改善魁北克省内外的临终关怀服务具有相关性。
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