Zupanc Seth N, Quintiliani Lisa M, LeClair Amy M, Paasche-Orlow Michael K, Volandes Angelo, Penumarthy Akhila, Henault Lori, Itty Jennifer E, Davis Aretha D, Lakin Joshua R
Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA.
School of Medicine, University of California San Francisco, San Francisco, CA, USA.
Am J Hosp Palliat Care. 2024 Aug 28;42(8):10499091241267917. doi: 10.1177/10499091241267917.
Optimal care for seriously ill and older patients often involves advance care planning (ACP), goals-of-care (GOC) conversations, and specialty palliative care consultation, three sometimes overlapping, yet distinct practices. Insufficient staffing and investment in these areas have limited their availability.
We explored the facilitators and barriers to successful implementation of the VIDEO-PCE trial. The intervention aimed to increase patient engagement in ACP, GOC, and by establishing Palliative Care Educators, a new clinical role integrated into existing hospital wards.
This qualitative interview study employed a semi-structured interview guide tailored to the interviewee's clinical role. The interviews elicited perceptions of the facilitators and barriers to integration of palliative care educators (PCEs) into existing workflows. We developed deductive codes a priori and inductive codes as we coded interview transcripts.
SETTING/SUBJECTS: Medical/surgical floor clinical colleagues, palliative care team members, and PCEs from both participating sites were interviewed.
Twenty-four individuals were interviewed (12 clinical staff of medical and surgical wards, seven palliative care team members, and five PCEs). Four themes were identified: (1) The work completed by the PCEs provided a foundation for future palliative care involvement; (2) Constituting the new role in practice required revision and creativity; (3) Communication was important to providing continuity of care; and (4) Establishing trust catalyzed the acceptance of the role.
The creation and implementation of a new role within existing clinical workflows posed some challenges but were felt to relieve staff from some work burden and allow more patients to engage in ACP and GOC conversations.
ClinicalTrials.gov Identifier: NCT04857060.
对重症和老年患者的最佳护理通常涉及预先护理计划（ACP）、护理目标（GOC）对话以及专科姑息治疗咨询，这三种做法有时相互重叠，但又各不相同。这些领域的人员配备不足和投资有限，限制了它们的可及性。
我们探讨了成功实施VIDEO - PCE试验的促进因素和障碍。该干预措施旨在通过设立姑息治疗教育工作者这一融入现有医院病房的新临床角色，提高患者对ACP和GOC的参与度。
这项定性访谈研究采用了根据受访者临床角色量身定制的半结构化访谈指南。访谈引出了对将姑息治疗教育工作者（PCE）融入现有工作流程的促进因素和障碍的看法。我们在对访谈记录进行编码时，预先制定了演绎编码和归纳编码。
地点/受试者：来自两个参与地点的内科/外科病房临床同事、姑息治疗团队成员和PCE接受了访谈。
共访谈了24人（12名内科和外科病房临床工作人员、7名姑息治疗团队成员和5名PCE）。确定了四个主题：（1）PCE完成的工作为未来姑息治疗的参与奠定了基础；（2）在实践中确立新角色需要修订和创新；（3）沟通对于提供持续护理很重要；（4）建立信任促进了对该角色的接受。
在现有临床工作流程中创建和实施新角色带来了一些挑战，但人们认为这减轻了工作人员的一些工作负担，并使更多患者能够参与ACP和GOC对话。
ClinicalTrials.gov标识符：NCT04857060。
