德国和荷兰养老院的临终关怀：2022年关于养老院工作人员观点的横断面研究。
End-of-life care in German and Dutch nursing homes: a cross-sectional study on nursing home staff's perspective in 2022.
作者信息
Bauer Ann-Kathrin, Fassmer Alexander Maximilian, Zuidema Sytse U, Janus Sarah I M, Hoffmann Falk
机构信息
Department of Health Service Research, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany.
Institute of Medical Genetics, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany.
出版信息
Arch Public Health. 2024 Jun 14;82(1):85. doi: 10.1186/s13690-024-01316-2.
BACKGROUND
As society ages, the need for nursing home care is steadily increasing and end-of-life care of nursing home residents has become increasingly more important. End-of-life care differs between Germany and the neighbouring Netherlands. For example, a much higher proportion of German compared to Dutch nursing home residents is hospitalized at the end of life. Therefore, the aim of this study was to evaluate end-of-life care in German and Dutch nursing homes.
METHODS
In this cross-sectional study, a postal survey was sent to 600 randomly selected German and Dutch nursing homes each and addressed to the nursing staff management. Participants were asked to estimate the percentage of nursing home residents whose wishes for emergency situations (e.g. cardiopulmonary resuscitation) are known and to indicate whether facilities offer advanced care planning (ACP). They were also asked to estimate whether general practitioners (GPs)/elder care physicians (ECPs) and nursing home staff are usually well trained for end-of-life care. Finally, participants were asked to estimate the proportion of nursing home residents who die in hospital rather than in the nursing home and to rate overall end-of-life care provision.
RESULTS
A total of 301 questionnaires were included in the analysis; 199 from German and 102 from Dutch nursing homes (response 33.2% and 17.0%). German participants estimated that 20.5% of residents die in the hospital in contrast to the Dutch estimation of 5.9%. In German nursing homes, ACP is offered less often (39.2% in Germany, 75.0% in the Netherlands) and significantly fewer wishes for emergency situations of residents were known than in Dutch nursing homes. GPs were considered less well-trained for end-of-life care in Germany. The most important measures to improve end-of-life care were comparable in both countries.
CONCLUSION
Differences in (the delivery and knowledge of) end-of-life care between Germany and the Netherlands could be observed in this study. These could be due to structural differences (ECPs available 24/7 in the majority of Dutch nursing homes) and cultural differences (more discussion on quality of life versus life-sustaining treatments in the Netherlands). Due to these differences, a country-specific approach is necessary to improve end-of-life care.
背景
随着社会老龄化，对养老院护理的需求稳步增加，养老院居民的临终护理变得越来越重要。德国和邻国荷兰的临终护理存在差异。例如，与荷兰养老院居民相比，德国居民在生命末期住院的比例要高得多。因此，本研究的目的是评估德国和荷兰养老院的临终护理情况。
方法
在这项横断面研究中，向德国和荷兰各600家随机选择的养老院发送了邮政调查问卷，对象是护理人员管理层。参与者被要求估计知晓居民在紧急情况（如心肺复苏）下意愿的比例，并指出机构是否提供临终关怀计划（ACP）。他们还被要求估计全科医生（GPs）/老年护理医生（ECPs）和养老院工作人员在临终护理方面是否通常接受过良好培训。最后，参与者被要求估计在医院而非养老院死亡的养老院居民比例，并对整体临终护理服务进行评分。
结果
共有301份问卷纳入分析；199份来自德国养老院，102份来自荷兰养老院（回复率分别为33.2%和17.0%）。德国参与者估计20.5%的居民在医院死亡，而荷兰的估计为5.9%。在德国养老院，提供ACP的情况较少（德国为39.2%，荷兰为75.0%），而且与荷兰养老院相比，知晓居民紧急情况意愿的情况明显更少。在德国，全科医生被认为在临终护理方面的培训不足。两国改善临终护理的最重要措施具有可比性。
结论
本研究观察到德国和荷兰在临终护理（提供方式和知识方面）存在差异。这些差异可能是由于结构差异（荷兰大多数养老院24/7都有老年护理医生）和文化差异（荷兰对生活质量与维持生命治疗的讨论更多）。由于这些差异，需要采取针对具体国家的方法来改善临终护理。
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