晚期慢性疾病患者及其家属的体验，以及在初级保健中进行结构化的姑息治疗护士访视和多专业病例会议后的体验 - 基于定性访谈的演绎归纳内容分析（KOPAL 研究）。

Experiences of patients with advanced chronic diseases and their associates with a structured palliative care nurse visit followed by an interprofessional case conference in primary care - a deductive-inductive content analysis based on qualitative interviews (KOPAL-Study).

机构信息

Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.

Institute for General Practice and Palliative Care, Hannover Medical School, Hannover, Germany.

出版信息

BMC Prim Care. 2024 Sep 4;25(1):323. doi: 10.1186/s12875-024-02572-5.

DOI:10.1186/s12875-024-02572-5

PMID:39232658

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11373434/

Abstract

BACKGROUND

Chronic, non-malignant diseases (CNMD) like chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF) and dementia in advanced stages are very burdensome for patients. Timely palliative care with strong collaboration between general practitioners (GPs) and specialist palliative home care (SPHC) teams can reduce symptom burden, hospitalization rates, hospitalization costs and overall healthcare costs. The KOPAL-study on strengthening interprofessional collaboration for patients with palliative care needs tested the effect of an intervention comprising of a SPHC nurse assessment and an interprofessional case conference. This qualitative evaluative study explores patients', proxies' and their associates' motivation to participate in the KOPAL-study and views on the (benefits of the) intervention.

METHODS

We interviewed 13 male and 10 female patients as well as 14 proxies of patients with dementia and six associates of study participants using a semi-structured interview guide. All interviews were digitally recorded, transcribed verbatim and analysed with deductive-inductive qualitative content analysis.

RESULTS

Motivation for participation was driven by curiosity, the aim to please the GP or to support research, respectively to help other patients. Few interviewees pointed out to have expected positive effects for themselves. The nurse visit was evaluated very positively. Positive changes concerning health care or quality of life were reported sparsely. Most study participants did not prepare for the SPHC nurse assessment. They had no expectations concerning potential benefits of such an assessment, the interdisciplinary case conference and an early integration of palliative care. The majority of interviewees reported that they did not talk about the nurse visit and the interprofessional case conference with their GPs.

CONCLUSION

Our results lead to the conclusion that SPHC nurses can serve as an advocate for the patient and thereby support the patients' autonomy. GPs should actively discuss the results of the interdisciplinary case conference with patients and collaboratively decide on further actions. Patient participation in the interdisciplinary case conference could be another way to increase the effects of the intervention by empowering patients to not just passively receive the intervention.

TRIAL REGISTRATION

DRKS00017795 German Clinical Trials Register, 17Nov2021, version 05.

摘要

背景

慢性非恶性疾病（CNMD），如晚期慢性阻塞性肺疾病（COPD）、充血性心力衰竭（CHF）和痴呆症，给患者带来了沉重的负担。通过全科医生（GP）与专科姑息治疗家庭护理（SPHC）团队之间的密切合作，及时提供姑息治疗，可以减轻症状负担、降低住院率、减少住院费用和整体医疗费用。KOPAL 研究旨在加强有姑息治疗需求患者的跨专业合作，测试了一项干预措施的效果，该干预措施包括 SPHC 护士评估和跨专业病例会议。这项定性评估研究探讨了患者、其代理人及其相关人员参与 KOPAL 研究的动机，以及他们对（干预措施的）看法。

方法

我们使用半结构化访谈指南采访了 13 名男性和 10 名女性患者以及 14 名痴呆症患者的代理人和 6 名研究参与者的相关人员。所有访谈均进行了数字记录、逐字转录，并采用演绎-归纳定性内容分析进行分析。

结果

参与的动机是出于好奇心，目的是取悦 GP 或支持研究，或者帮助其他患者。很少有受访者表示对自己有预期的积极影响。护士访问受到了非常积极的评价。报告的健康状况或生活质量的积极变化很少。大多数研究参与者没有为 SPHC 护士评估做准备。他们对这种评估、跨学科病例会议以及姑息治疗的早期整合没有任何预期的好处。大多数受访者表示，他们没有与 GP 谈论护士访问和跨学科病例会议。